Early ureteral stent removal reduces urinary tract infection risk without increasing complications in living donor kidney transplantation: a systematic review and meta-analysis

Background: Ureteral stenting is commonly performed after ureteral neoimplantation during kidney transplantation to reduce major urological complications (MUCs). However, the optimal duration of ureteral stent removal remains unclear, as longer stenting is associated with increased risk of urinary tract infection (UTI). This study compared UTI and MUC incidence between early (3 weeks) and late (>3 weeks) stent removal following living donor kidney transplantation (LDKT). Methods: We systematically searched the PubMed/MEDLINE, Science Direct, Cochrane, and EMBASE databases through January 2024 for randomized and observational studies comparing early (3 weeks) and late (>3 weeks) ureteral stent removal in LDKT recipients. The following Medical Subject Headings were used for the search: kidney transplantation, renal transplantation, and ureteral stent or stent. Stenting duration, UTI incidence, and MUCs (obstruction and urinary leakage) were recorded, and a meta-analysis was performed to pool odds ratios (ORs). Results: Eight studies (five randomized controlled trials and three cohort studies) comprising 2,148 LDKT recipients were included. Early removal significantly reduced the incidence of UTIs compared with late removal (OR, 0.53; 95 confidence interval CI, 0.32-0.87). Six studies assessed MUC incidence, revealing no significant difference between early and late removal (OR, 0.69; 95% CI, 0.28-1.65). Subgroup analysis demonstrated that early stent removal does not increase the risk of obstruction (OR, 0.76; 95% CI, 0.22-2.66) or urinary leakage (OR, 0.62; 95% CI, 0.18-2.14) compared with late removal. Conclusions: Performing ureteral stent removal less than 3 weeks after LDKT reduces UTI risk without increasing MUCs relative to later removal. © The Korean Society for Transplantation.