*Purpose: Transplant ureteral strictures are a major cause of morbidity following kidney transplantation and often require surgical revision including ureteroureterostomy (UU) and neocystoureterostomy (NC). Our objective was to determine the long term graft survival and patient outcomes based on the site of ureteral stricture and type of ureteral revision surgery.

*Methods: We conducted a retrospective longitudinal cohort study of kidney recipients that developed urological complications necessitating surgical intervention following transplantation; 27 patients were identified over a 10 year period. Outcomes measured included type of operation, complications, readmissions, urologic infection, renal function, acute rejection, graft and patient survival.

*Results: Of the 27 patients, 4 had proximal strictures, 1 had a mid-ureteral stricture, 18 had distal strictures, and 4 had pan-ureteral strictures. Readmission rates and renal function pre- and post-revision were similar among groups. Patients with pan-ureteral strictures tended to have more recurrent strictures (4/9 vs 4/18, p=0.233) while also being less likely to develop infections (5/9 vs 11/18, p=0.077). Rejection rates were similar among proximal (25%), distal (42.8%) and pan-ureteral (25%) strictures. When comparing NC with UU, there was no difference in readmission rates (13/24 vs 2/4, p=0.735) or pre- and post-revision creatinine (mean 2.67 vs 1.59mg/dL); however, those with NC were more than two times more likely to develop infections (16/24 vs. 1/4, p=0.114) but were only half as likely to develop recurrent strictures (7/24 vs. 2/4, p=0.409). Overall, graft survival was 85.7% and patient survival was 96.4% with a mean follow-up of 6.2 years. Average baseline creatinine was 2.6 mg/dL prior to surgical revision with an average nadir creatinine of 1.5 mg/dL post revision. There were four graft failures over the study period, all in the NC group with average time to graft failure of 8.1 years. When comparing patients who received a kidney from a deceased donor (N=20) vs. a living donor (N=7), rates of infection (12/20 vs. 4/7, p=0.895) and readmission (10/20 vs. 4/7, p=0.745) were similar. However, deceased donors were more likely to develop rejection (7/20 vs. 1/7, p=0.302), graft failure (4/20 vs. 0/7, p=0.199), and stricture recurrence (7/20 vs. 1/7, p=0.302) after ureteral revision.

*Conclusions: These results suggest that ureteral stricture location and revision type do not significantly impact renal function or readmission rates, but may influence stricture recurrence and urologic infections. However, long-term graft and patient survival is better than expected in this cohort of kidney transplant recipients undergoing surgical intervention for complicated ureteral strictures.

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