Navigating the landscape of graft ureteral strictures in renal transplant recipients: A single-center case series and literature review

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Background and Objectives: Graft ureteral stricture is an uncommon but important complication after renal transplantation that may compromise graft function. Endoscopic balloon dilatation offers a minimally invasive treatment, though regional data are limited. The study aimed to determine the number of endoscopic balloon dilatation procedures required to manage graft ureteral strictures and to evaluate their success rate as a bridge to or alternative to surgical revision. Methodology: A single-center retrospective case series included 10 recipients treated between May 2018 to August 2025 conducted at the Department of Kidney Transplant Surgery, Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore, Pakistan, with outcomes assessed based on the number and success of dilatation procedures. Results: Among 1,070 living-donor renal transplants, graft ureteral strictures occurred in 10 patients, yielding an incidence of 0.93% (95% CI:0.45–1.71%). No ureteral stricture has occurred in our pediatric patients. Recipients were predominantly male (80%) with a median age of 28.50 (IQR:9) years. Most strictures developed within two months post-transplant, presenting as a rise in serum creatinine (median 2.51 (IQR:2.06) mg/dL at diagnosis). The median number of balloon dilatations per patient was 3.50 (IQR: 2). Outcomes included successful resolution in four patients (40%), surgical revision in four patients (40%), and periodic double J stent replacement in two patients (20%). All patients and graft were stable at one year with stable renal function (median serum creatinine 1.60 (IQR:0.44 mg/dL); median eGFR 44.9 (IQR:13.42) mL/min/1.73 m2). Conclusion: Balloon dilatation demonstrated limited long-term success, with only 40% achieving sustained resolution. A majority required surgical revision or ongoing stenting, suggesting its role as a bridging rather than definitive therapy.

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