Forgotten or retained ureteric stents are an under-recognized yet important cause of graft dysfunction in kidney transplant recipients. These stents, often inserted during the ureteroneocystostomy, may become encrusted if not removed within the recommended timeframe. Encrustation can lead to obstruction, infection, and even irreversible graft loss. Inadequate stent tracking systems, poor patient follow-up, and lapses in communication between treating teams contribute to this preventable complication. We describe the case of a 42-year-old woman with immunoglobulin A nephropathy who underwent a live-unrelated kidney transplant in 2018. She maintained stable graft function until early 2020, when she presented with a gradual rise in serum creatinine following an episode of acute gastroenteritis. Despite normalization of elevated calcineurin inhibitor levels, graft function continued to deteriorate, and an allograft biopsy was planned. Prebiopsy ultrasonography revealed moderate hydronephrosis, renal parenchymal calcifications, and a heavily encrusted forgotten ureteric stent. Computed tomography confirmed extensive encrustations and renal pelvic calculi. Cystoscopic removal was unsuccessful, necessitating percutaneous nephrolithotomy with retrieval of the encrusted stent and placement of a new ureteric stent. The patient’s renal function returned to baseline following the procedure. Implementation of structured stent tracking systems–such as electronic stent registries, automated reminder alerts, and patient follow-up checklists–along with regular interdisciplinary reviews and patient counseling, is crucial to prevent forgotten stents and associated complications in kidney transplant programs.
Prakash et al. (Thu,) studied this question.