Evaluation of a ureteral stent removal protocol in adult kidney transplant recipients

Existing literature on best practices to reduce the risk of infectious complications associated with ureteral stent removal in kidney transplant recipients is limited. Prior to 2021, a formal process surrounding stent removal was not in place at our institution. In June 2021, a stent removal protocol was established. This protocol included: obtaining a pre-procedure urine culture, prescribing universal culture-directed antimicrobial prophylaxis, earlier stent removal post-transplant, and patient education. We performed a retrospective, quasi-experimental study of kidney transplant recipients who had their stent removed between July 2020 and June 2022. The primary outcome was the incidence of infectious complications within 30 days. Infectious complications were defined as urinary tract infection (UTI), bacteremia due to urinary source, or hospitalization, emergency department visit, or outpatient encounter for possible UTI. Secondary objectives included infectious and immunologic complications within 30 days to one year from transplant. During this study period, 239 adult kidney transplant recipients were included, 88 patients in the pre-protocol group and 151 patients in the protocol group. The median time to stent removal was shorter in the protocol group (25 versus 36 days, p<0.001). More patients in the protocol group received pre-procedure antibiotics (99% versus 36%, p<0.001). Infectious complications were higher in the pre-protocol group (9% versus 3%, p=0.035). Overall, the stent removal protocol was associated with fewer infectious complications [OR (95% CI): 0.18 (0.05, 0.73]. Further investigation is necessary to determine which individual interventions (if any), drive this benefit.