Renal transplant nephrolithiasis: Presentation, management and follow‐up with control comparisons

Author:

Sandberg Maxwell1ORCID,Cohen Adam1,Escott Megan1,Marie‐Costa Claudia2,Temple Davis2,Rodriguez Rainer2,Gordon Alex3,Rong Anita2,Andres‐Robusto Brian2,Roebuck Emily H.2ORCID,Ye Emily2,Underwood Gavin2,Choudhary Arjun4,Whitman Wyatt1,Webb Christopher J.5,Stratta Robert J.5,Wood Kyle4,Assimos Dean16,Mirzazadeh Majid1

Affiliation:

1. Department of Urology Atrium Health Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA

2. Wake Forest University School of Medicine Winston‐Salem North Carolina USA

3. Edward Via College of Osteopathic Medicine Blacksburg Virginia USA

4. Tufts University School of Medicine Boston Massachusetts USA

5. Section of Transplantation, Department of Surgery Atrium Health Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA

6. Department of Urology University of Alabama Birmingham Medical Center Birmingham Alabama USA

Abstract

AbstractObjectivesTo analyse the presentation, management and long‐term outcomes of renal transplant patients who formed kidney stones in their allograft. The secondary aim was to identify risk factors for stone formation in this cohort.Materials and MethodsPatient information from an institutional renal transplant database was used to identify individuals who both did and did not form kidney stones following renal transplantation. Computerized tomography (CT) imaging was used to make the diagnosis of kidney stones and measure stone size. Age‐ and gender‐matched controls never forming a stone in their allograft were used for comparative analysis to identify risk factors for stone formation in transplant patients.ResultsA total of 8835 transplant patients were included in the study, of which 128 (1.4%) formed a kidney stone in their allograft after surgery. The mean time to kidney stone identification was 6.2 years, and the mean number of stones formed was 1.7, with a mean maximum size dimension on a CT scan of 5.7 mm per stone. A total of 26 patients were subjected to stone‐removing procedures, the most common being ureteroscopy (42.3%). The primary intervention failed in eight patients requiring a secondary intervention, and percutaneous nephrolithotomy (PCNL) had the lowest success rate (60%). A total of 164 controls were identified. In comparison to controls, stone formers had lower serum calcium (p = 0.008), lower estimated glomerular filtration rates (p = 0.019), higher lymphocyte counts (p = 0.021) and greater rate of urinary tract infection (p = 0.003). Graft failure rates were the same (p = 0.524), but time to graft failure was significantly longer in stone patients compared with controls (p = 0.008).ConclusionsThe rate of stone formation is low in transplant patients. Success rates for stone treatment vary based on the surgery selected, with PCNL being the worst. Graft survival rates were equivocal, but survival time was better in stone patients. Our analysis calls for further investigation of this important topic.

Publisher

Wiley

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