Routine prophylactic stenting reduces the incidence of major urological complications in kidney transplant recipients

Key messages

– The incidence of major urological complications was reduced by inserting a stent during kidney transplant surgery.

– Stent insertion reduces the risk of major urological complications even when the stent is only left in place for a short period of time after transplant (≤ 14 days).

– The impact of stenting on urinary tract infections was uncertain. However, when the stent was only left for a short period, or people were on preventative antibiotics, stenting did not increase the number of urinary tract infections.

What is kidney failure, and how should it be treated?

Kidney failure occurs when a person’s kidneys no longer function well enough to keep them alive. Kidney transplantation is the treatment of choice for kidney failure, improving quality of life and extending the recipient’s life expectancy. Interventions aimed at reducing the burden of post-transplant complications are a major area of research in the transplant community.

The ureter (drainage tube for urine) from the donated kidney needs to be joined to the recipient’s bladder during surgery. Major urological complications (e.g. urine leak and blockage) can occur following transplantation. These happen at the location of this join.

What did we want to find out?

We wanted to determine the benefits and harms of routine stenting (adding a temporary plastic tube to this join) in kidney transplant recipients to prevent major urological complications.

What did we do?

We searched for all trials that assessed the benefits and harms of randomly allocating transplant recipients to receive a stent during surgery or not. We compared and summarised the trials’ results and rated our confidence in the information based on factors such as trial methods and size.

What did we find?

We included 12 studies involving 1960 transplant recipients. The number of major urological complications was reduced by using a stent. Stent insertion also reduces the risk of major urological complications even when the stent is only left in place for a short period of time after transplant (≤ 14 days).

The impact of stenting on urinary tract infections was uncertain. However, when the stent was only left in place for a short period, or people were on preventative antibiotics, stenting did not cause more UTIs. The presence of a stent did not appear to increase blood in the urine. More studies are needed to investigate the use of selective versus universal prophylactic stenting for the unresolved issues of quality of life and cost.

What are the limitations of the evidence?

We are reasonably confident that inserting a stent during kidney transplantation reduces the number of major urological complications. We are less certain of the results for the number of urinary tract infections, the effect on patient and kidney survival, increased blood in the urine, quality of life, and the overall cost.

How up-to-date is the evidence?

The evidence is current to June 2024.