Umbilical Vein Catheter Versus Double J Stent for Ureteric Anastomosis in Renal Transplantation: A Single Centre, Open Label, Randomized Trial
Transplant Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: 215
Keywords: Kidney transplantation, Post-operative complications
Session Information
Session Name: Concurrent Session: Kidney: Surgical Technique/Complications
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:39pm-2:51pm
Location: Room 115-AB
Introduction: Double J (DJ) stents are used routinely in renal transplantation to prevent ureteric complications. A recent Cochrane review of literature showed that routine prophylactic stenting reduces the risk of major ureteric complications.
Aim: The aim of the study was to compare the use of Umbilical Vein Catheter (UVC) to DJ stents in renal transplants. Primary end point was ureteric complication rate. Secondary end points were UTIs, re-operation or radiological interventions, and cost effectiveness.
Methods: 300 patients were randomized using a sealed envelope technique.151 to DJ stents & 149 to UVC. There was a significant conversion rate from UVC to DJ stent, intra-operatively (30%).Eventually 187 DJ stents & 98 UVCs were included in final analysis. Intention to treat (ITT) and per protocol (PP) analysis were done. Fishers' exact test was used for two-sided p values. Absolute risk with 95% confidence interval (CI) & number need to treat (NNT) were calculated.
Results: Patient demographics were similar in both groups. Both ITT & PP analyses showed no significant increase in ureteric complications with the UVC (p=0.1194 & 0.1286, respectively; AR 3.5%; 95%CI=-1.22% to 8.21%; NNH=29). Regarding UTIs, ITT showed a significant increase in DJ stent group (p<0.0001) with AR 21.6%, 95% CI=11.5 to 31.7; NNT=5. However, the PP analysis failed to show any significant difference between the 2 groups (p=0.5937; AR 3.56; 95% CI= -7.71 to 14.84; NNT=29). There was a significant cost difference between the 2 groups with DJ stents costing £848 per patient (cost of stent itself plus day surgery procedure of flexible cystoscopic removal) and UVCs costing just £0.80. This resulted in a savings of over £83,000 in this study.
Conclusions: This prospective randomized trial showed that UVCs are comparable to DJ stents in terms of ureteric complications. However, ITT analysis showed a higher risk of UTIs with DJ stents. But there was a significant conversion rate, making per protocol analysis insignificant. UVCs need to be evaluated further in future trials, to tap the potential huge cost benefit.
To cite this abstract in AMA style:
Swaroop V, Pereira A, Smith S, Masood O, Pararajasingam R, Augustine T, Riad H, Mehra S, Tavakoli A. Umbilical Vein Catheter Versus Double J Stent for Ureteric Anastomosis in Renal Transplantation: A Single Centre, Open Label, Randomized Trial [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/umbilical-vein-catheter-versus-double-j-stent-for-ureteric-anastomosis-in-renal-transplantation-a-single-centre-open-label-randomized-trial/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress