Risk Factors and Rates of Occurrence of Ureteral Stricture Formation Following Renal Transplantation: A Literature Review

Objectives: Ureteral strictures after kidney transplant are an uncommon but significant cause of morbidity. This systematic literature review investigated risk factors for ureteral stricture formation after renal transplant and overall rate of strictures after renal transplant. Materials and methods: We used PubMed, Medline, and Cochrane Library to search for relevant articles concerning renal transplant and posttransplant complications (ureteral stricture). We included the key words "kidney transplant" OR "renal transplant" AND "ureteral stenosis/stricture" AND "adults." We selected (1) clinical studies involving ureteral strictures following renal transplant; (2) studies with outcomes that included ureteral stricture rate; and (3) studies that had preoperative data on mean donor patient age, sex, and donor type (living or deceased). Case reports, case series, letters to the editors, and non-English articles were excluded. Results: We identified 455 articles initially; 356 articles were screened, and 13 original articles were included in the study. Together, the studies reported on 292 posttransplant ureteral strictures. Kidney graft multiplicity (P = .02), donor age (P < .001), stentless procedures (P = .04), recipient age (P < .001), donation after circulatory death (P = .04), cold ischemia time (P = .027), warm ischemia time (P = .05), history of nephrolithiasis (P = .001), history of prostate conditions (P = .024), history of bladder recatheterization (P = .006), history of bladder outlet obstruction (P = .007), double kidney transplant (P = .037), and panel reactive antibodies were associated with posttransplant ureteral stricture formation. Mean ureteral stricture rate was 0.08 +/- 0.04 (range, 0.34%-65%). Mean period from transplant to stricture formation was 17 +/- 24 months. Mean follow-up was 36 +/- 16 months. Conclusions: Ureteral stricture can potentially affect graft function and patient outcomes. Understanding and managing the risk factors associated with ureteral stricture are crucial for improving posttransplant prognosis.