Abstract: SA-PO498
Impact of Early Ureteric Stent Removal on Urinary Tract Infection and Ureteric Complication after Kidney Transplantation – A Single Centre Experience
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Chong, Stephanie, Royal London Hospital, London, United Kingdom
- Mahalingasivam, Viyaasan, Mid Essex Hospitals NHS Trust, Harrow, United Kingdom
- Youssouf, Sajeda, Barts Health NHS Trust, London, United Kingdom
- Blunden, Mark, Royal London Hospital, London, United Kingdom
Background
Recurrent urinary tract infection (UTI) is a common cause of renal allograft dysfunction as well as a burden on patient quality of life and the health economy.
Methods
We performed a retrospective study of consecutive deceased donor transplants undertaken at our centre between January 2012 and June 2016 to determine the effectiveness of strategies which had been established to reduce rates of UTI in our patient cohort. These included changing pre-operative antibiotic prophylaxis from co-amoxiclav to meropenem in January 2014, whilst a cohort of patients underwent the intra-operative tying of ureteric stents to indwelling urinary catheters, in order to allow for early concurrent removal on day 5. The remaining patients continued to undergo standard cystoscopic stent removal after six weeks. Our aim was to determine the difference these changes made to the incidence of UTI in the first three months after transplantation. 555 adult deceased donor transplants were studied of which 23 were excluded due to early explantation. 115 underwent early stent removal whilst 418 underwent later cystoscopic removal.
Results
There was no difference in the number of patients with at least one UTI between with groups (37.0% with early stent removal, 38.3% with later stent removal, p=0.83) or with more than two UTIs (15.6% vs 14.8%, p=0.83). There was no difference in the average number of UTIs per patient (1.02 vs 1.05, p=0.43). There was also no difference in the incidence of extended-spectrum beta-lactamases (ESBL) (6.09% vs 7.42%, p=0.58) or hospital admission (10.5% vs. 6.09%, p=0.15). There was no difference in the rate of ureteric complication (6.9% vs 5.7%, p=0.85).
There was however, an increase in the rate of UTI per patient after the antibiotic protocol was switched from co-amoxiclav to meropenem (0.68 to 1.33, p<0.05). The rate of ESBL was similar (5.49% vs 8.36%, p=0.20) in both groups.
Conclusion
Early ureteric stent removal does not appear to reduce the incidence or frequency of UTI and there was no significant difference in ureteric complication rates in our patient cohort. These findings suggest that early stent removal is a potentially viable and cost effective surgical strategy in renal transplantation but further prospective randomised controlled trials are needed for validation.