Ureteral stricture formation in laparoscopically procured living donor kidney transplantation

Introduction: To identify the incidence of and risk factors for ureteral stricture formation in laparoscopically procured living donor kidney transplantation (LLDKT). Materials and methods: An IRB approved retrospective review of our institution's living donor database was performed. Patients were divided into two cohorts, those with ureteral strictures requiring procedural intervention and those without evidence of ureteral strictures. Analysis was limited to those patients with at least one year of follow up. Results: Of the 584 LLDKT's performed at our institution since June 1999, 510 had at least 1 year of follow up. Four hundred and ninety-six patients had no evidence of stricture disease (97.2%) while 14 (2.8%) developed clinically significant ureteral strictures. The incidence of delayed graft function was higher in the stricture group (21% versus 3%, p<0.0001) while the intraoperative placement of a ureteral stent was associated with decreased incidence of ureteral strictures (21% of the stricture group received stents compared to 58% in the no stricture group, p=0.006). In multivariable logistic regression models, delayed graft function was strongly associated with the development of clinically significant ureteral stricture disease (OR 19.3; 95% Cl 3.59, 104.2; p=0.001) while the placement of intraoperative ureteral stents was protective against ureteral stricture formation (OR 0.09; 95% Cl: 0.02,0.49; p=0.005). Conclusion: Delayed graft function and nonuse of ureteral stents are associated with the development of ureteral strictures following LLDKT