*Purpose: Routine placement of ureteral stent in pediatric kidney transplantation prevents complications by reducing vesicoureteral junction kinking, and promoting drainage from the transplant kidney to the bladder. Stents prevent urinary leak, stenosis, or fistula. However, stents may predispose to urinary tract infections (UTI), and can obstruct, leading to increased morbidity and costs, migrate, or cause hematuria, or bladder irritation. Non-local patients may need to remain close to the transplant hospital until the stent is removed. In January 2020, we reduced the planned time from transplant to stent removal from 6 weeks to less than 3 weeks in patients without complex urological anatomy

*Methods: Retrospective study of all pediatric patients transplanted at Lucile Packard Children’s hospital from 2018 to present. Patients were divided into 2 groups- I: stent removal >21 days post-transplant, II: stent removal <21 days post-transplant. Hospital readmissions and adverse urologic events were reviewed, along with time to return home for outreach patients.

*Results: A total of 79 pediatric patients were included in the study, those with complex urological anatomy and multiorgan transplants were excluded. 45 had stent removed >21 days (Group I), and 34 had stent removed <21 days (Group II). In Group I, 6 (13.3%) had urologic complications. One patient had acute kidney injury (AKI) from obstruction of the stent, AKI improved post removal. Five (11.1%) patients had confirmed febrile UTIs. In Group II, 2 (5.8%) patients were hospitalized from urologic concerns potentially related to the stent. Both patients had febrile UTIs and their stents were removed. The difference of outcomes in the two groups did not reach statistical significance. There were no urinary leaks, stenosis or fistulas. For the non-local patients (47% of the total cohort), the length of relocation was 42.9 (+13.14 days) compared to 30.9 days (+7.69 days), p=0.002.

*Conclusions: Early ureteral stent removal within 21 days in pediatric renal transplant recipients is safe. Neither group had major urologic complications. Minor urologic complications were not statistically significantly different and were infrequent. Remote patients with less local resources, were however were able to safely return home earlier, which could add to reduction in overall cost and improvement in patient quality of life.

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