Table 1_Post-transplant ureteral stenosis: donor-related risk factors, graft outcome and surgical management.docx

Introduction<p>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.</p>Methods<p>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.</p>Results<p>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).</p>Discussion<p>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.</p>