Abstract：
Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F-30F) was more frequently performed than mini-PCNLs (16F-20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%-100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team.
摘要：
目的：肾移植是治疗终末期肾病的一种方法，能提供更好的生活质量和生存。在可能影响同种异体移植物的并发症中，尿石症可能会有严重的后果,导致免疫功能低下患者发生急性肾损伤（AKI）或脓毒症事件。同种异体结石可以通过经皮肾镜取石术（PCNL）治疗。这项Cochrane风格审查的目的是评估PCNL在肾移植患者中的安全性和有效性。
方法：在文献中进行了全面的搜索，包括1982年7月至2023年6月之间的文章，仅选择了英文原始文章进行本评论。
结果：最终综述包括9篇文章（108例患者）。平均年龄为46.4+/-8.7岁，男女比例为54:44。从移植到尿石症发作的平均时间为47.54（/-23.9）个月。出现时的主要症状是AKI（32.3％），其次是UTI和发烧(24.2%)，少尿（12.9%）。平均结石大小为20.1mm（+/-7.3mm），石头位于肾盂或骨盆（41％），输尿管-骨盆交界处(23.1%),或输尿管近端（28.2%）。PCNL(22-30F)比小型PCNL(16-20F)更频繁(52.4%vs.47.6%）。超声（USS）引导穿刺（42.9%），透视（14.3%），或两者(42.9%)。结石清除率（SFR）和并发症发生率分别为92.95%（范围：77-100%）和5.5%，分别,只有一个主要的并发症报告。术后,输尿管支架和肾造口术通常放置在47%，4名患者需要再次看PCNL。平均随访32.5个月,复发率为3.7%(4/108),平均肌酐水平为1.37mg/dL（+/-0.28）。
结论：PCNL仍然是一种安全有效的治疗方法，允许在一步手术中治疗大结石。获得良好的SFR，轻微并发症的风险较低。这些患者应与肾脏或移植团队一起在腔内泌尿外科中心接受治疗。
方法：在文献中进行了全面的搜索，包括1982年7月至2023年6月之间的文章，仅选择了英文原始文章进行本评论。
结果：最终综述包括9篇文章（108例患者）。平均年龄为46.4+/-8.7岁，男女比例为54:44。从移植到尿石症发作的平均时间为47.54（/-23.9）个月。出现时的主要症状是AKI（32.3％），其次是UTI和发烧(24.2%)，少尿（12.9%）。平均结石大小为20.1mm（+/-7.3mm），石头位于肾盂或骨盆（41％），输尿管-骨盆交界处(23.1%),或输尿管近端（28.2%）。PCNL(22-30F)比小型PCNL(16-20F)更频繁(52.4%vs.47.6%）。超声（USS）引导穿刺（42.9%），透视（14.3%），或两者(42.9%)。结石清除率（SFR）和并发症发生率分别为92.95%（范围：77-100%）和5.5%，分别,只有一个主要的并发症报告。术后,输尿管支架和肾造口术通常放置在47%，4名患者需要再次看PCNL。平均随访32.5个月,复发率为3.7%(4/108),平均肌酐水平为1.37mg/dL（+/-0.28）。
结论：PCNL仍然是一种安全有效的治疗方法，允许在一步手术中治疗大结石。获得良好的SFR，轻微并发症的风险较低。这些患者应与肾脏或移植团队一起在腔内泌尿外科中心接受治疗。
