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Purpose <p>Ureteral stenosis remains a significant urological complication after kidney transplantation. This study aimed to identify independent risk factors for the development of post-transplant ureteral stenosis and to evaluate their temporal impact using survival analysis in a contemporary cohort.</p> Methods <p>A retrospective single-center cohort study was conducted, including 342 deceased donor kidney transplant recipients between 2014 and 2024. The primary endpoint was the time to radiologically confirmed ureteral stenosis within the first post-transplant year. Univariate analysis and Kaplan-Meier survival curves were used to identify associated factors. A multivariable Cox proportional hazards model was constructed to determine independent predictors, adjusting for clinically relevant variables.</p> Results <p>The incidence of ureteral stenosis was 11.1% (<i>n</i> = 38). Multivariable Cox regression identified urinary fistula as the strongest associated factor (Hazard Ratio [HR]: 8.28; 95% CI: 3.87–17.72; <i>p</i> &lt; 0.001), drastically reducing median stenosis-free survival to 188.9 days. Diabetes mellitus showed a borderline association with stenosis (HR: 2.41; 95% CI: 1.02–5.72; <i>p</i> = 0.046). Conversely, the prophylactic use of a double-J stent was an independent protective factor, reducing the risk of stenosis by 72% (HR: 0.28; 95% CI: 0.11–0.73; <i>p</i> = 0.009). Postoperative urinary tract infection showed a non-significant trend (HR: 1.89; <i>p</i> = 0.079).</p> Conclusion <p>Urinary fistula was the strongest predictor of ureteral stenosis, underscoring the importance of its prevention. Routine prophylactic double-J stenting appeared to be an effective protective strategy. Diabetes mellitus showed a borderline association with stenosis and may identify a subgroup requiring closer postoperative urological surveillance; this finding should be interpreted cautiously and confirmed in larger studies.</p>

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Risk factors for post-renal transplant ureteral stenosis: a survival analysis in a contemporary cohort

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Nicolás Sierrasesumaga Martín,
  • Juan Ramón Torrecilla Garcia-Ripoll,
  • Miguel Pascual Samaniego,
  • Sergio Martin Martin,
  • Esther Valsero Herguedas,
  • Raúl Calvo González,
  • Fatima Castroviejo Royo,
  • Laura Pesquera Ortega,
  • Antonio José Alonso Villalba,
  • María Consuelo Conde Redondo,
  • Jesus Calleja Escudero

摘要

Purpose

Ureteral stenosis remains a significant urological complication after kidney transplantation. This study aimed to identify independent risk factors for the development of post-transplant ureteral stenosis and to evaluate their temporal impact using survival analysis in a contemporary cohort.

Methods

A retrospective single-center cohort study was conducted, including 342 deceased donor kidney transplant recipients between 2014 and 2024. The primary endpoint was the time to radiologically confirmed ureteral stenosis within the first post-transplant year. Univariate analysis and Kaplan-Meier survival curves were used to identify associated factors. A multivariable Cox proportional hazards model was constructed to determine independent predictors, adjusting for clinically relevant variables.

Results

The incidence of ureteral stenosis was 11.1% (n = 38). Multivariable Cox regression identified urinary fistula as the strongest associated factor (Hazard Ratio [HR]: 8.28; 95% CI: 3.87–17.72; p < 0.001), drastically reducing median stenosis-free survival to 188.9 days. Diabetes mellitus showed a borderline association with stenosis (HR: 2.41; 95% CI: 1.02–5.72; p = 0.046). Conversely, the prophylactic use of a double-J stent was an independent protective factor, reducing the risk of stenosis by 72% (HR: 0.28; 95% CI: 0.11–0.73; p = 0.009). Postoperative urinary tract infection showed a non-significant trend (HR: 1.89; p = 0.079).

Conclusion

Urinary fistula was the strongest predictor of ureteral stenosis, underscoring the importance of its prevention. Routine prophylactic double-J stenting appeared to be an effective protective strategy. Diabetes mellitus showed a borderline association with stenosis and may identify a subgroup requiring closer postoperative urological surveillance; this finding should be interpreted cautiously and confirmed in larger studies.