Long-Term Clinical Impact of Vesicoureteral Reflux in Kidney Transplantation

Favi, Evaldo; Spagnoletti, Gionata; Valentini, Anna Lia; Tondolo, Vincenzo; Nanni, Giuseppe; Citterio, Franco; Castagneto, Marco

doi:10.1016/j.transproceed.2009.03.052

Cited by 23 publications

(29 citation statements)

References 6 publications

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“…Favi et al compared 15 recipients with VUR to 22 without [32]. Each patient had at least one urinary tract infection (UTI) per year and was more than 2 years out from transplant.…”

Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.

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“…Favi et al compared 15 recipients with VUR to 22 without [32]. Each patient had at least one urinary tract infection (UTI) per year and was more than 2 years out from transplant.…”

Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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“…Currently, the evidence available is poor and mainly derived from very small and underpowered studies, thus limiting data interpretation. In a small cohort series of 37 renal transplant patients, Favi et al (19) found no effect of VUR on graft survival or renal function at 5 years, as indicated by VCUG. The reported VUR incidence of 41% (15/37 patients) is in accordance with our findings.…”

Section: Discussionmentioning

confidence: 95%

“…However, the actual impact of this condition has been a subject of ongoing debate (19,22,(26)(27)(28)(29)(30). To the best of our knowledge, this study is the largest series of deceased and living donor kidney allograft recipients in which the effect of early VUR on the incidence of UTI, rejection rates, and graft and patient survival was analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…However, data on long-term graft function and survival were not available in this study. In both studies, VCUGs were only performed for clinical indications (19,22).…”

Section: Discussionmentioning

confidence: 99%

“…Some reports suggest that urinary tract infections (UTIs) compromise renal allograft survival (14)(15)(16)(17), but the impact of VUR on the risk of developing UTI is less certain (18). In addition, the effect of VUR on graft and patient survival remains unclear, and studies evaluating short-term survival rates have revealed inconsistent results (19)(20)(21)(22). The aim of this study was to investigate the effect of early posttransplantation VUR on long-term clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Value of Routine Voiding Cystourethrography After Renal Transplantation

Margreiter

Györi

Böhmig

et al. 2013

American Journal of Transplantation

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The impact of vesicoureteral reflux (VUR) on renal allograft outcomes is debatable, with small cohort studies reporting controversial results. The objective of this retrospective study was to evaluate long-term clinical effects of early VUR in a large cohort of kidney transplant patients. Posttransplantation voiding cystourethrography was used to evaluate 646 consecutive kidney transplant recipients before discharge. The study endpoints included VUR grade, death-censored graft or patient survival, renal function, proteinuria and occurrence of urinary tract infections (UTIs). Of the 646 recipients, 263 (40.7%) were diagnosed with VUR. VUR grade II was most common (19.8%), followed by grades III (10.2%), I (7.9%) and IV (2.8%). VUR was less common in transplantations performed by experienced compared to inexperienced surgeons (36% vs. 48%; p = 0.004). VUR did not affect death-censored graft or patient survival and was not associated with proteinuria or occurrence of UTIs. Patients with VUR had a lower eGFR at 1 year after transplantation than did patients without VUR (60 vs. 52 mL/min/1.73 m 2 ; p = 0.02), although this difference was not observed at 3 and 5 years after transplantation. We conclude that early VUR, a common finding among renal transplant patients, may not have a meaningful impact on longterm transplant outcomes.

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