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Piana A. et al., 2023: Kidney stones in renal transplant recipients: A systematic review

Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy; Departamento de Urología, Universidad de Turín, Turín, Italy.
Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
Servicio de Urología, Centro Médico de la Universidad de Toledo, Toledo, OH, United States.
Departamento de Urología, Universidad de Turín, Turín, Italy.
Servicio de Urología, Trasplante Renal y Andrología, Hospital Universitario de Rangueil, Toulouse, France.
Servicio de Urología y Trasplante Renal, Hospital Universitario La Concepción, Marsella, France.
Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy.
Sección de Urología, Servicio de Cirugía, Hospital Annunziata, Cosenza, Italy.
Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy.

Abstract

Introduction: Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment.

Evidence acquisition: A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss.

Evidence synthesis: A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%.

Conclusions: Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.

Actas Urol Esp (Engl Ed). 2023 Aug 12:S2173-5786(23)00101-4. doi: 10.1016/j.acuroe.2023.08.003. Online ahead of print.PMID: 37574010 Free article. Review. English, Spanish.

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Comments 1

Hans-Göran Tiselius on Friday, 12 January 2024 08:45

This report is the second one published during the period July-September that deals with management of stones in transplanted kidneys.

Findings in the 41 reports, summarized in this article, give heterogenous results that varied considerably. This outcome in patients treated with different methods are summarized in the following table:

https://www.storzmedical.com/images/blog/233004.png

The overall stone-free rate was 80%, but the stone-free rate after SWL is difficult to determine because of variations in reported data, and a quick survey of data given in the Tables show stone-free rates between 0 and 100%.
Although the stones mainly were composed of CaOx, uric acid stones also were encountered, but whether some of the latter stone were treated by oral dissolution is not mentioned.
It had indeed been interesting to know the progress of stones left for surveillance in a long-term perspective.

Hans-Göran Tiselius

This report is the second one published during the period July-September that deals with management of stones in transplanted kidneys. Findings in the 41 reports, summarized in this article, give heterogenous results that varied considerably. This outcome in patients treated with different methods are summarized in the following table: [img]https://www.storzmedical.com/images/blog/233004.png[/img] The overall stone-free rate was 80%, but the stone-free rate after SWL is difficult to determine because of variations in reported data, and a quick survey of data given in the Tables show stone-free rates between 0 and 100%. Although the stones mainly were composed of CaOx, uric acid stones also were encountered, but whether some of the latter stone were treated by oral dissolution is not mentioned. It had indeed been interesting to know the progress of stones left for surveillance in a long-term perspective. Hans-Göran Tiselius
Monday, 17 June 2024