Vesicoureteral Reflux After Kidney Transplantation In Children

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations;  Pediatrics / Children's Health
Article Date: 07 Oct 2007 - 0:00 PST

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UroToday.com- A study from Spain by Barrero, et al. analyzed the frequency of vesicoureteral reflux and the factors that may attribute to its appearance after kidney transplantation in the pediatric population. This was a retrospective study that examined the prevalence of post-transplant vesicoureteral reflux in a total of 181 kidney transplants performed in children at their center between 1978 and 2004. For the patients who required corrective surgery for this problem they analyzed pre-transplant residual diuresis, pretransplant pathology, and post-transplant problems related to vesicoureteral reflux. They also reviewed the form of presentation as to whether the reflux was to the graft or to the native kidney. They also looked at the degree of reflux and the surgical technique used to correct the reflux.

Ten patients (5.5%) needed surgery to correct reflux. Nine of these children had reflux to the graft while one had reflux to the native kidney. Reflux was manifested as a urinary tract infection in six children and progressive graft failure in one. Bladder disorders that favored vesicoureteral reflux were present in eight patients. These consisted of a non-compliance bladder, detrusor overactivity, posterior urethral valves, or urethral stenosis.

The ground then found that lengthening the submucosal tunnel stopped urinary tract infections in all 10 patients. The voiding cystourethrograms 6 months after reimplantation showed resolution of the reflux in 8 patients and a reduction in the degree of reflux in two patients. It seems that the high percentage of post-transplant vesicoureteral reflux in these pediatric patients was related with higher frequencies of bladder pathology. The group concluded that during the initial transplantation those children who have some form of pretransplant bladder pathology should have a tunneled ureter fashioned.

Barrero R, Fijo J, Fernandez-Hurtado M, García-Merino F, León E, Torrubia F.

Pediatric Transplantation. 11(5): 498-503, August 2007
doi:10.1111/j.1399-3046.2006.00668.x

Reported by UroToday.com Contributing Editor Pasquale Casale, M.D

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