Anuria since birth: does it impact outcome of kidney transplant in infants?

Abstract

Kidney transplantation (txp) in infants has recently made much progress but provides a unique challenge in infants anuric since birth. Little data exists on outcome of renal txp recipients with anuria since birth. Retrospective chart review was done for outcome of 27 children with wt ≤15 kg and they were divided into two groups: Group A (N=21) with urine output and Group B (N=6) anuric since birth had their urological complications and long-term outcome compared. Median age at the time of txp 18 vs 23 months, mean wt 10.8 vs 11.8 kg, and mean ht 77 cm in both, mean follow-up post-txp: 9.4 vs 5.6 years, and neurological problems were noted in 48% and 33% in Group A and Group B. There was no graft thrombosis or post-transplant lymphoproliferative disease and only two rejections. Anuric Group B were older, had more post-txp urological surgeries (66% vs 19%) and UTIs (66% vs 38%) compared to Group A. The overall graft survival at 1, 5, and 10 years was 96%, 86%, and 70%; patient survival at 1, 5, and 10 years was 96%, 85%, and 85%. Long-term graft outcomes in small children, anuric prior to txp, were excellent despite higher rates for UTIs and urological complications.

Long-Term Outcomes of Renal Transplant in Recipients With Lower Urinary Tract Dysfunction

“…1,3,[9][10][11][12][13][14][15] These studies have several limitations. Many had low numbers of patients included in the analyses (6-21 patients) 3,[12][13][14][16][17][18][19] and did not include a control group but merely compared their results to average graft and patient survival statistics. 1,13,16,18 Not all control groups were matched.…”

“…Many had low numbers of patients included in the analyses (6-21 patients) 3,[12][13][14][16][17][18][19] and did not include a control group but merely compared their results to average graft and patient survival statistics. 1,13,16,18 Not all control groups were matched. 9,11,12 Most control groups consisted of patients with a "non-urologic" cause of ESRD but did not specify the cause of ESRD further or account for the differing causes as a confounding factor.…”

“…One study 18 compared bladder augmentation first versus transplant first, finding no difference in incidence of urinary tract infection after transplant or subsequent graft function. There is a higher incidence of posttransplant urinary tract infections in patients with prior LUTD 9,[11][12][13]15,16 ; however, studies have suggested that urinary tract infections do not affect long-term graft function. 10,21 The most common cause of graft loss in those with LUTD is so-called "chronic rejection."…”

Is a reduction in cystometric bladder capacity in anuric infants post‐renal transplant really no big deal?

“…In light of this discord, we were grateful to read a recent publication that adds valuable insight into this topic. In this edition of Pediatric Transplantation , Shefali Vyas et al . shared their experience with 27 renally‐transplanted children weighing <15 kg at the time of transplantation at the Children's Kidney Center Barnabas Health in West Orange, NJ, USA.…”

“…It is unknown whether the six infants from Vyas's study had previously normal bladders as the authors did not provide an in‐depth background of the anuric ESRD patients from birth. The previously normal defunctionalized bladder will often show decreased capacity, involuntary bladder contraction, and/or decreased compliance .…”