Changing trends in the management of posttransplant ureteric stricture

Abstract

Abstract Introduction: Chronic kidney disease (CKD) is a common disease now. Diabetes and hypertension are the main cause. Renal transplant is a gold standard treatment. Posttransplant stricture is also common, and changing trends in management are emerging. Materials and Methods: It is a retrospective observational study in a tertiary care hospital in East India. The study duration was from January 2019 to December 2021. In total, 140 patients were studied, including both live and cadaveric transplants. A patient who developed posttransplant hydronephrosis or presented with acute kidney injury was evaluated with ultrasonography, intravenous urography, contrast-enhanced computerized tomography, and magnetic resonance imaging. Management was done with double J (DJ) stenting, percutaneous nephrostomy (PCN) insertion, or surgical intervention. Results and Analysis: Twelve (8.6%) patients out of 140 developed posttransplant ureteric stricture. Five (41.7%) out of 12 patients were managed with long dura DJ stenting, and five (41.7%) were managed with PCN insertion and serial follow-up. Only two (16.7%) required ureteric reimplantation. Discussion: Posttransplant ureteric stricture is a common complication following renal transplantation. Common causes are increased cold ischemia time, ureteral edema, clots, tumors, calculi, lymphocele, abscess, and hematoma. Other causes include kinking of the ureter and previously unrecognized pelviureteric junction obstruction. In the literature, the incidence of posttransplant ureteric stricture ranges from 2% to 10% in one study; and in another study, it is 1% to 9%. In our study, it is 8.6%. Conclusion: Diagnosis of the posttransplant ureteric stricture should be prompt, and management should be given as early as possible for better graft survival.