Piana A, Basile G, Masih S, Bignante G, Uleri A, Gallioli A, Prudhomme T, Boissier R, Pecoraro A, Campi R, Di Dio M, Alba S, Breda A, Territo A
Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy; Departamento de Urología, Universidad de Turín, Turín, Italy.
Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
Actas Urol Esp (Engl Ed). 2024 Jan-Feb;48(1):79-104. doi: 10.1016/j.acuroe.2023.08.003. Epub 2023 Aug 12.
Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment.
A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss.
A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%.
Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.
肾移植受者发生结石可能是一种危险情况，存在器官功能受损的潜在风险。
截至2023年2月进行了系统的文献检索。主要目的是评估肾移植（KT）受者结石的发生率。次要目的是评估结石形成的时间、结石的位置和成分、可能的治疗选择以及移植肾丢失的发生率。
共有41项非随机研究，纳入699例患者，符合我们的纳入标准。结石诊断时的年龄在29至53岁之间。尿路结石的发生率在0.1%至6.3%之间，通常在肾移植术后12个月后诊断。大多数结石在肾盏或肾盂中被诊断出来。草酸钙成分最为常见。考虑了不同的治疗策略，即主动监测、输尿管镜检查、经皮/联合方法或开放手术。15.73%的患者接受了体外冲击波碎石术（ESWL），而26.75%的患者接受了内镜碎石术或结石取出术。18.03%的患者接受了经皮肾镜取石术，3.14%的患者接受了联合方法。5.01%的病例进行了开放取石术。总体结石清除率约为80%。
肾移植中的结石是一种罕见情况，通常在术后一年后诊断，主要位于肾盏和肾盂，草酸钙成分更为常见。每种积极治疗在结石清除率方面都有良好效果，因此应根据患者特征和外科医生偏好选择手术技术。
