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

Abstract

Objectives: Lower urinary tract dysfunction can lead to chronic kidney disease, which, despite surgical intervention, will progress to end-stage renal disease, requiring dialysis. Urologic pathology may damage a transplanted kidney, limiting patient and graft survival. Although smaller studies have suggested that urinary tract dysfunction does not affect graft or patient survival, this is not universally accepted. Northern Ireland has historically had the highest incidence of neural tube defects in Europe, giving rich local experience in caring for patients with lower urinary tract dysfunction. Here, we analyzed outcomes of renal transplant recipients with lower urinary tract dysfunction versus control recipients. Materials and Methods: We identified 3 groups of kidney transplant recipients treated between 2001 and 2010; those in group 1 had end-stage renal disease due to lower urinary tract dysfunction with prior intervention (urologic surgery, long-term catheter, or intermittent self-catheterization), group 2 had end-stage renal disease secondary to lower urinary tract dysfunction without intervention, and group 3 had end-stage renal disease due to polycystic kidney disease (chosen as a relatively healthy control cohort without comorbid burden of other causes of end-stage renal disease such as diabetes). The primary outcome measured, graft survival, was death censored, with graft loss defined as requirement for renal replacement therapy or retransplant. Secondary outcomes included patient survival and graft function. Results:In 150 study patients (16 patients in group 1, 64 in group 2, and 70 in group 3), 5-year deathcensored graft survival was 93.75%, 90.6%, and 92.9%, respectively, with no significant differences in graft failure among groups (Cox proportional hazards model). Five-year patient survival was 100%, 100%, and 94.3%, respectively. Conclusions: Individuals with a history of lower urinary tract dysfunction had graft and patient survival rates similar to the control group. When appropriately treated, lower urinary tract dysfunction is not a barrier to successful renal transplant.

Does renal transplant in children with LUTD improve their bladder function?

“…Also, regarding recipient age at transplantation, onset, and duration of dialysis, none of the 12 studies described a significant difference in LUTD patients compared with NLUT. This is similar to our results 6‐15 …”

“…After RT, need for de novo measures to optimize LUTD was reported totally in 33 (15.5%) of 214 LUTD compared with 33.3% in our study cases. ACP was needed in five cases (2.3%) after RT 6,7,11‐15 . This difference from our study may be because we included all measures needed to optimize LUTD, for example, anticholinergic rather than limiting to invasive methods like CIC or ACP.…”

“…However, those studies did not report the changes that occurred in the LUT function under renal graft 4,5 . In addition, we compared our results to 10 other studies on the outcomes of pediatric RT in patients with LUTD alone or compared to a control group with NLUT 6‐15 …”

“…CIC was the most common needed measure to manage LUTD in 90 cases (46%) either alone or in combination with anticholinergic or augmentation. Main type of augmentation was ileocystoplasty in 62.7% of total augmented cases 4‐13,18 …”

Simultaneous laparoscopic bilateral nephroureterectomy, cadaveric kidney allotransplantation and performance of vesicostomy in a patient with neurogenic bladder

“…Опубликованы работы, результаты которых показывали, что нет разницы в коэффициентах выживаемости трансплантата и выживаемости пациентов [10][11][12]. В контролируемых исследованиях пациенты с нижней мочевой дисфункцией имели коэффициент смертности и выживаемости, аналогичный контрольной группе без дисфункции мочевого пузыря, однако имеется высокий риск инфекции МВП, что в свою очередь сопровождается минимизацией иммуносупрессивной терапии и в дальнейшем может привести к неблагоприятному исходу [13][14][15][16]. Реципиентам почечного трансплантата, имеющим в анамнезе ДНМП, требуются специальные хирургические методики формирования мочевых путей, обеспечивающие адекватный отток мочи, которые могут быть выполнены как предварительный этап или симультанно с трансплантацией почки.…”