Oudmaijer Christiaan A J, Muller Kelly, van Straalen Erika, Minnee Robert C, Kimenai Diederik J A N, Reinders Marlies E J, van de Wetering Jacqueline, IJzermans Jan N M, Terkivatan Turkan
Division of Hepatobiliary and Transplantation Surgery, Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
PLoS One. 2025 Jan 30;20(1):e0317991. doi: 10.1371/journal.pone.0317991. eCollection 2025.
Urological complications after kidney transplantation, due to the ureteroneocystostomy, are associated with significant morbidity, prolonged hospital stay and even mortality. Ureteral stents can minimize the number of complications but are not consistently used, as previous studies were retrospective in nature. We aim to prospectively determine the most effective stenting approach.
We performed a non-blinded single-centre randomised controlled trial in an academic hospital. Kidney transplant recipients were randomised to either a Single-J stent or a Double-J stent, removed according to respective protocols. Primary outcome was PCN placement within six months. Secondary outcomes encompassed urinary tract infections, cost-effectiveness, and hospital admission time. The study was conducted from November 2018 to August 2023, during which 300 recipients were included with complete follow-up.
PCN was performed in 14.5% in the Single-J group (21/145) and 4.5% in the Double-J group (7/155), p = 0.003. Multivariable logistic regression, corrected for recipient age, BMI, sex, and donor type, showed an OR of 0.26 [0.10, 0.61] (OR [95%CI]). To prevent PCN in one recipient, 10 would have to receive the Double-J. All secondary outcomes were comparable, whereas hospital admission time and cost-effectiveness analysis heavily favoured Double-J stenting. An important limitation was that Single-J participants were unable to leave, even if their recovery allowed earlier discharge.
This trial showed that Double-J stenting consistently reduced urological complications from 14.5% to 4.5%, while being highly cost-effective. Transplant surgeons should favour Double-J stenting to minimise the risk of complications.
肾移植术后因输尿管膀胱吻合术导致的泌尿系统并发症与显著的发病率、延长的住院时间甚至死亡率相关。输尿管支架可减少并发症的数量，但由于既往研究本质上是回顾性的，其使用并不一致。我们旨在前瞻性地确定最有效的支架置入方法。
我们在一家学术医院进行了一项非盲单中心随机对照试验。肾移植受者被随机分为单J型支架组或双J型支架组，并根据各自的方案取出支架。主要结局是在六个月内进行经皮肾穿刺造瘘术（PCN）。次要结局包括尿路感染、成本效益和住院时间。该研究于2018年11月至2023年8月进行，在此期间纳入了300名接受者并进行了完整的随访。
单J型支架组中有14.5%（21/145）进行了PCN，双J型支架组中有4.5%（7/155）进行了PCN，p = 0.003。在对受者年龄、体重指数、性别和供体类型进行校正的多变量逻辑回归分析中，显示比值比（OR）为0.26 [0.10, 0.61]（OR [95%置信区间]）。为了预防一名受者进行PCN，需要10名受者接受双J型支架。所有次要结局均具有可比性，而住院时间和成本效益分析强烈支持双J型支架置入。一个重要的局限性是，即使单J型支架组的参与者恢复情况允许提前出院，他们也无法离开。
该试验表明，双J型支架置入可将泌尿系统并发症持续从14.5%降低至4.5%，同时具有很高的成本效益。移植外科医生应优先选择双J型支架置入以降低并发症风险。
