REvIEw Ureteric Stenting in Kidney Transplants Samir Damji, 1 Angela Atinga, 2 David Hakim, 3 Nadey Hakim 4 DOI: 10.6002/ect.2012.0270 Abstract The routine use of ureteric stents after a kidney transplant for prophylactic measures is debatable. Concerns have been raised regarding the potential complications and costs of routine stenting. Here, we review the literature based on studies in favor of and against the routine placement of ureteric stents in kidney transplant patients. Some studies have shown a benefit to patients who have routine stents placed, while others have not shown this benefit but have highlighted the associated financial implications. The decision to stent renal transplant patients will depend on robust multicenter, randomized controlled trials being carried out, as well as both short-term and long- term cost analyses. Key words: Renal, Ureteric, Double J, Infection, Complication, Allograft Introduction Urologic complications after a renal transplant are a major cause of morbidity, and have an incidence rate of between 2% and 33%. 1-5 They occur in the form of urinary leakage or ureteric stenosis, with the use of stents in treating well-established complications. 1,6,7 However, prophylactic or routine ureteric stenting for kidney recipients after transplant remains controversial. There have been instances in which complications have been reported to decrease; other studies have reported the opposite. Therefore, varying practices of routine versus selective stenting have evolved. In this article, we review the arguments for and against routine stenting including in various transplant subgroups, the costs and risks, and the optimum duration of stent placement. In favor of stenting There is grade 1 evidence for prophylactic use stenting of kidney transplant recipients. A Cochrane review by Wilson and colleagues 1 showed that major urologic complications were fewer in the stented group of patients compared with those patients that did not have stents, incorporating all donor types (relative risk [RR] 0.24; 95% confidence interval [CI] 0.07-0.77). Similarly, a longitudinal study involving double J stents in living-related transplant recipients showed a decrease in ureteral complications in those patients with stents compared with those patients without stents (P < .05). 8 These results have been replicated by several authors including a metaanalysis, which showed a significantly lower incidence of urologic complications in the stented group (P < .0001; odds ratio [OR] 0.24; 95% CI 0.10-0.57). 4,7,9 Urologic complication rates greater than 30% are now reduced to about 5% in some centers. 5 against stenting Prophylactic stenting causes concern for some surgeons because of stent-related complications. These include early complications (such as infection in an already immune-compromised patient and urinary tract infections), as these have been shown to be increased in patients with ureteric stents, 10 with one study reporting a RR of 1.49 (P = .03; 95% CI 1.04-2.15). 1 Additionally, Tavakoli and associates 11 From the 1 Royal Free London NHS Foundation Trust, Department of Renal Transplantation, 2 Hillingdon Hospital NHS Foundation Trust, Department of Surgery, 3 Royal College of Surgeons in Ireland, and the 4 Imperial College London, West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, UK Acknowledgements: This study was not supported by any grants, and the authors have no conflicts of interest to declare. Corresponding author: Professor Nadey Hakim, The West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0QT, United Kingdom Phone: +44 208 383 5164 Fax: +44 208 383 5169 E-mail: nadey@globalnet.co.uk Experimental and Clinical Transplantation (2013) 2: 109-111 Copyright © Başkent University 2013 Printed in Turkey. All Rights Reserved.