Renal Transplantation In Children With Lower Urinary Tract Dysfunction Of Different Origin: A Single-Center Experience

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations;  Pediatrics / Children's Health
Article Date: 26 Apr 2008 - 0:00 PDT

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UroToday.com - A study out of Turkey reported a single center experience evaluating patient graft survivals in patients who had renal transplantation with concomitant lower urinary tract dysfunction. The group evaluated 70 pediatric transplant patients and found 11 of them to display severe lower urinary tract dysfunction. Videourodynamic testing was done preoperatively on all the patients and postoperatively on those that required repeat studies. The cause of urologic disorder in these patients was neuropathic bladder in 5 patients and a history of posterior urethral valves in 6. Amongst the 11 patients, 6 needed to empty their bladder with clean intermittent catheterization regimens. 5 patients needed an augmentation cystoplasty to increase their bladder capacity and compliance prior to transplantation.

All patients underwent renal transplantation only if low intravesical pressures were achieved with adequate bladder drainage or cystoplasty. All the patients post transplant were treated with a calcineurin based immunosuppressive therapy. 3 patients received kidneys from cadaveric donors and the remaining 8 from living donors. Of the patients 9 were male and 2 were female. The mean patient age at the time of transplantation was 15 years with a range of 11.3 to 19.7. The median duration of transplantation was 36 months with a range of 6 to 62 months. They had 3 patients who had undergone pre-transplant augmentation on clean intermittent catheterization regimens who experienced recurrent symptomatic UTI's. The group also found that they had one patient who also underwent an augmentation cystoplasty that had a urinary leak and ureteral stricture in the early postoperative transplant period. This patient was just treated by an antegrade double pigtail stent that was subsequently removed without any discussion as to any further sequelae.

The group went on to state that severe lower urinary tract dysfunction plays a critical role in graft survival. They emphasized for satisfactory outcome of kidney transplantation that all these patients with lower urinary tract dysfunction should be rehabilitated aggressively and appropriately. They also state that not all patients need to have augmentation cystoplasty and if low intravesical pressures with adequate bladder drainage could be achieved, the results are comparable. They further state that if augmentation cystoplasty is intended, they prefer to have it done before renal transplantation to avoid the possible effects of immunosuppressive therapy. Some of these effects are delayed wound healing and the possibility of a severe infection with manipulation of the bowel. They also believe that the use of prophylactic antibiotics can reduce the incidence of urinary tract infection.

They conclude by stating that based on their analysis renal transplantation is safe and effective as long as the underlying urologic pathology is properly managed prior to undertaking any transplantation. It appears quite obvious to me that severe lower urinary tract dysfunction in deed carries a high risk for the grafted kidney according to this study.

Reported by UroToday.com Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia

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