Post-transplant ureteral stenosis: donor-related risk factors, graft outcome and surgical management

Introduction Kidney transplantation remains the preferred treatment for end-stage renal disease; however, the increasing use of extended-criteria donors has been associated with a higher incidence of postoperative complications. Methods We retrospectively analyzed 471 kidney transplant recipients at the University of Cologne between 2012 and 2022 to evaluate the incidence, risk factors, clinical outcomes, and surgical management of ureteral stenosis. Results Ureteral stenosis occurred in 6.37% and was significantly associated with older donor age within the extended-criteria donor range (65 vs. 56 years, p = 0.006), multiple renal arteries (33.3% vs. 10.2%, p < 0.001), and BK virus infection, as reflected by higher rates of BK viruria (26.7% vs. 7.0%, p = 0.002) and BK viraemia (26.7% vs. 8.6%, p = 0.005). Renal function was significantly impaired in recipients with ureteral stenosis at 6 months, 1 year, and 2 years after transplantation. Death-censored graft survival was significantly lower in the stenosis group (79.7% vs. 93.3%, p = 0.01). Discussion Ureteral transposition and ureteroneocystostomy demonstrated comparable outcomes, long-term renal function and graft survival supporting individualization of surgical technique based on anatomical and patient-specific factors.