132 Cochrane review on routine intraoperative ureteric stenting for kidney transplant recipients Free

In kidney transplant patients, ureteric stents have been used to treat, and attempt to minimize the risk of, major urological complications (MUCs). In 2013 we published a Cochrane review (7 trials) demonstrating the efficacy of stents to reduce MUC. This study updates that landmark publication including more recent trials.

The Cochrane Kidney and Transplant Specialised Register was searched to identify (quasi-) randomised controlled trials to include in meta-analysis. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

A further 4 studies have been published since the 2013 paper. With a moderate certainty of evidence, prophylactic ureteric stenting reduces MUC for both urine leak and ureteric obstruction (11 studies: 1834 participants: RR 0.30, 95% CI 0.16 to 0.55; P < 0.0001; I² = 16% number needed to treat of 17). In contrast to the previous version of this Cochrane review, subgroup analysis shows that stents in situ for both short duration (≤14 days) and long duration (>14 days) reduced the risk of MUC. It is uncertain whether stenting has an impact on the development of urinary tract infection (UTI) across 10 studies (very low certainty). We found the risk of UTI was not increased with short-duration stenting (9 days) versus no stent. The impact on graft and patient survival and other stent-related complications remains uncertain.

Routine prophylactic stenting reduces the incidence of MUCs, even in the short duration (≤14 days). The impact of stents on UTI incidence remains unclear.