Prophylactic Ureteral Stenting in Kidney Transplantation: A Multivariable and Propensity Score-matched Analysis of 3407 Recipients From NSQIP Transplant

BACKGROUND: Prophylactic ureteral stenting during kidney transplantation has traditionally been used to reduce major ureteral complications (MUCs), including ureteric leaks and stenosis. Contemporary data on its benefit-risk balance are limited. METHODS: A retrospective review of the prospectively collected National Surgical Quality Improvement Program in Transplant beta phase database (2017-2019) was conducted. The incidence of MUC and urinary tract infections (UTIs) was compared between patients who did and did not receive prophylactic stents. Multivariable regression and propensity score matching were used to assess the independent effect of stent use on MUC and UTI. RESULTS: A total of 3407 kidney transplant recipients were included, 2574 (75.6%) of whom received a prophylactic ureteral stent. MUC rates were similar between nonstented and stented groups (2.4% versus 2.5%; P = 0.96) but UTI rates were higher in stented patients (7.4% versus 3.2%; P < 0.001). Stented patients tended to have higher body mass index (28.0 versus 26.8; P < 0.001), more often smokers (5.4% versus 2.0%; P < 0.001), and have longer warm ischemia times (38.3 versus 31.5 min; P < 0.001). In multivariable analysis, stent usage was associated with higher UTI (odds ratio, 2.22; 95% confidence interval, 1.48-3.43; P < 0.001), but not lower MUC (odds ratio, 0.91; 95% confidence interval, 0.56-1.54; P = 0.72). In the propensity score-matched cohort (n = 712 pairs), stented patients still had a higher rate of UTI (8.1% versus 3.4%; P < 0.001), but similar rates of stenosis (1.7% versus 1.5%; P = 1.0) and leak (1.0% versus 1.0%; P = 1.0). CONCLUSIONS: This large multicenter cohort suggests that, in selected patients, not performing universal prophylactic ureteral stenting could result in lower UTI rates without a concomitant increase in ureteral complications.