Ureteric stenting in kidney transplant: optimal timing for stent removal

INTERVENTION: Following the establishment of general anaesthesia, an indwelling catheter will be inserted into the bladder and irrigated with neostigmine. urinary continuity will be re‐established by anastomosing the donor ureter to the recipient bladder using a standard technique over a double‐J ureteric stent as per our Transplant Unit's protocol. In the intervention arm, at the time the double‐J stent is inserted during the transplant operation the distal end of the stent will be sutured to the indwelling bladder catheter. At the time the bladder catheter is removed on day 4 post kidney transplant the ureteric stent will be simultaneously removed, eliminating the need for cystoscopy. CONDITION: Renal transplant PRIMARY OUTCOME: Graft outcome ‐ assessed using histology from renal biopsy, serum creatinine levels and estimated glomerular filtration rate (eGFR). Patient outcome ‐ where mortality rates will be used to assess outcome (all patients are followed up post‐renal transplant as part of the Australian and New Zealand Datavase of Transplantation (ANZDATA) so data on mortality rates will be retrieved from this source, data is linked using national health information numbers) SECONDARY OUTCOME: Major Urological Complications (defined as any structural or functional abnormality of the ureteric‐urinary bladder anastomosis, subclassified into either obstructive or leak complications, assessed using computed tomography (CT) scan, blood analysis, clinical examination and return to theatre for definitive diagnosis and management where indicated) INCLUSION CRITERIA: All adult patients (>16 years at time of transplant) placed on the waiting list for kidney transplantation at Auckland City Hospital will be eligible.