Double J is superior to externally draining ureteric stent in enhancing recovery after living donor kidney transplantation

M.H.D. Bruintjes, F.C.H. d' Ancona, J.C.M. Kusters, L.B. Hilbrands, M.C. Warlé

Thursday 15 march 2018

12:35 - 12:45h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 3: Clinical

Introduction

Prophylactic ureteral stenting in kidney transplantation has been proven to reduce urological complications, such as urine leakage and ureteral obstruction. However, there is no consensus on the optimal stent design. We aimed to compare the influence of Double J (JJ) catheters and externally draining ureteric stents on the early recovery after living donor kidney transplantation. 

Methods

Between April 2016 and October 2017 a prospective cohort study was performed on 80 recipients of living donor kidney transplants. The patients were divided in two cohorts, the first cohort received a externally draining ureteric stent (splint) in accordance with our standard protocol. The second cohort received a JJ catheter to stent the ureterovesical anastomosis. The splint was removed after 5 days, the JJ catheter after 2-3 weeks at the outpatient clinic by cystoscopy. Early recovery after surgery was daily monitored until patients were discharged. The primary outcome measure was the Quality of Recovery-40 (QoR-40) score. The Quality of Recovery-40 is a validated patient-rated questionnaire with a maximum score of 200, measuring 5 dimensions of recovery after surgery including comfort, emotions, physical independence, pain, and patient support. Secondary outcomes were components of pain scores, achievement of discharge criteria, length of hospital stay, and complications.

Results

The mean QoR-40 scores on postoperative day 5 of the recipients with JJ catheter and splint were 190.3 (SD 8.0) and 185.0 (SD 13.9) respectively, p 0.02. In accordance to the validated QoR-40 questionnaire, the difference of 6.3 score points on postoperative day 5 is a clinically relevant improvement in postoperative recovery, as result of the JJ catheter. Furthermore, when compared to patients with a splint, patients with a JJ catheter reached the discharge criteria earlier, and consequently their length of hospital stay was significantly shortened with 1 or 2 days. Daily pain scores were comparable between both groups, except for slightly raised pain scores in the double J group on postoperative days 1 and 2, which can be explained by earlier mobilization. Early urological complications were similar between the two groups.

Conclusion

Double J stenting improves the early postoperative recovery after living donor kidney transplantation, when compared to externally draining ureteric stents.