{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:40:06Z","timestamp":1787888406978,"version":"build-2784847793"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and objectives<\/jats:title>\n<jats:p>Urological complications after kidney transplantation, due to the ureteroneocystostomy, are associated with significant morbidity, prolonged hospital stay and even mortality. Ureteral stents can minimize the number of complications but are not consistently used, as previous studies were retrospective in nature. We aim to prospectively determine the most effective stenting approach.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We performed a non-blinded single-centre randomised controlled trial in an academic hospital. Kidney transplant recipients were randomised to either a Single-J stent or a Double-J stent, removed according to respective protocols. Primary outcome was PCN placement within six months. Secondary outcomes encompassed urinary tract infections, cost-effectiveness, and hospital admission time. The study was conducted from November 2018 to August 2023, during which 300 recipients were included with complete follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>PCN was performed in 14.5% in the Single-J group (21\/145) and 4.5% in the Double-J group (7\/155), p = 0.003. Multivariable logistic regression, corrected for recipient age, BMI, sex, and donor type, showed an OR of 0.26 [0.10, 0.61] (OR [95%CI]). To prevent PCN in one recipient, 10 would have to receive the Double-J. All secondary outcomes were comparable, whereas hospital admission time and cost-effectiveness analysis heavily favoured Double-J stenting. An important limitation was that Single-J participants were unable to leave, even if their recovery allowed earlier discharge.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This trial showed that Double-J stenting consistently reduced urological complications from 14.5% to 4.5%, while being highly cost-effective. Transplant surgeons should favour Double-J stenting to minimise the risk of complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317991","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T18:53:29Z","timestamp":1738263209000},"page":"e0317991","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long-term Double-J stenting is superior to short-term Single-J stenting in kidney transplantation"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-6514","authenticated-orcid":true,"given":"Christiaan A. J.","family":"Oudmaijer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Muller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"van Straalen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9494-3717","authenticated-orcid":true,"given":"Robert C.","family":"Minnee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8536-2083","authenticated-orcid":true,"given":"Diederik J. A. N.","family":"Kimenai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9543-567X","authenticated-orcid":true,"given":"Marlies E. J.","family":"Reinders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9117-2630","authenticated-orcid":true,"given":"Jacqueline","family":"van de Wetering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3558-1039","authenticated-orcid":true,"given":"Jan N. 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recipients","volume":"270","author":"FK Port","year":"1993","journal-title":"JAMA"},{"issue":"11","key":"pone.0317991.ref003","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1681\/ASN.V9112135","article-title":"Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up","volume":"9","author":"P Schnuelle","year":"1998","journal-title":"J Am Soc Nephrol"},{"issue":"6","key":"pone.0317991.ref004","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1056\/NEJM199408113310606","article-title":"Renal transplantation","volume":"331","author":"M Suthanthiran","year":"1994","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0317991.ref005","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.transproceed.2011.01.186","article-title":"Use of stenting in living donor kidney transplantation: does it reduce vesicoureteral complications?","volume":"43","author":"LF Dols","year":"2011","journal-title":"Transplant Proc"},{"issue":"9","key":"pone.0317991.ref006","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1016\/j.transproceed.2006.08.130","article-title":"Efficacy of interventional radiology procedures for the treatment of early ureteral complications after kidney transplantation","volume":"38","author":"R Miraglia","year":"2006","journal-title":"Transplant Proc"},{"issue":"3","key":"pone.0317991.ref007","doi-asserted-by":"crossref","first-page":"450","DOI":"10.4103\/0970-1591.70594","article-title":"Transplant ureter should be stented routinely","volume":"26","author":"R Mongha","year":"2010","journal-title":"Indian J Urol"},{"key":"pone.0317991.ref008","first-page":"CD004925","article-title":"Routine intraoperative ureteric stenting for kidney transplant recipients","volume":"4","author":"CH Wilson","year":"2005","journal-title":"Cochrane Database Syst 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Available from: https:\/\/www.onderzoekmetmensen.nl\/en\/trial\/21650 [cited 2024 Jan]."},{"key":"pone.0317991.ref018","unstructured":"Available from: https:\/\/www.transplantatiestichting.nl\/publicaties-en-naslag\/nts-jaarverslagen"},{"key":"pone.0317991.ref019","unstructured":"Troost JP, Trachtman H, Spino C, Kaskel FJ, Friedman A, Moxey-Mims MM, et al. Proteinuria reduction and kidney survival in focal segmental glomerulosclerosis. (1523-6838 (Electronic))."},{"key":"pone.0317991.ref020","unstructured":"Available from: https:\/\/www.cochranelibrary.com\/central\/doi\/10.1002\/central\/CN-01906069\/full [cited 2024 Jan]."},{"key":"pone.0317991.ref021","first-page":"431","article-title":"[The surgical treatment of congenital vesico-ureteral reflux]. Le Traitement Chirurgical Du Reflux V\u2019esico-Ur\u2019et\u2019eral Cong\u2019enital","volume":"63","author":"W Gregoir","year":"1964","journal-title":"Acta Chir Belg"},{"key":"pone.0317991.ref022","first-page":"122","article-title":"[Congenital Vesico-Ureteral Reflux] Le Reflux V\u2019esico-Ur\u2019et\u2019eral Cong\u2019enital","volume":"18","author":"W Gregoir","year":"1964","journal-title":"Urol Int"},{"key":"pone.0317991.ref023","first-page":"327","article-title":"Risk factors for urologic complications after kidney transplantation and impact in graft survival","volume":"14","author":"L Nino-Torres","year":"2022","journal-title":"Res Rep Urol"},{"issue":"6","key":"pone.0317991.ref024","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"JE Ware","year":"1992","journal-title":"Med Care"},{"issue":"5","key":"pone.0317991.ref025","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"R Rabin","year":"2001","journal-title":"Ann Med"},{"key":"pone.0317991.ref026","volume-title":"SF-36 physical and mental health summary scales: a user\u2019s manual","author":"New England Medical Center Hospital, Health Institute","year":"1994"},{"issue":"1","key":"pone.0317991.ref027","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12882-018-0893-6","article-title":"Factors associated with health-related quality of life in kidney transplant recipients in France","volume":"19","author":"Y Mouelhi","year":"2018","journal-title":"BMC Nephrol"},{"key":"pone.0317991.ref028","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1477-7525-5-54","article-title":"Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.I","volume":"5","author":"SS Farivar","year":"2007","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0317991.ref029","unstructured":"Rizopoulos D. 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