Renal function outcomes in pediatric patients with symptomatic reflux into the transplanted kidney treated with redo ureteroneocystostomy

Wang, Mary K; Chuang, Kai-wen; Li, Yang; Gaither, Thomas W.; Brakeman, Paul; Gonzalez, Lynette; Brennan, Jessica; Baskin, Laurence S.

doi:10.1016/j.jpurol.2018.01.024

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…26 We are unable to assess the bias due to the exclusion of many patients. In two more homogenous studies in patients with multicystic kidneys 27 and transplanted kidneys, 28 renal length has been shown to be useful. However, in our heterogenous groups of SFK patients the diagnostic performance of the renal length z-score was less convincing.…”

Section: Regression Analysismentioning

confidence: 99%

Renal length z‐score for the detection of dysfunction in children with solitary functioning kidney

et al. 2020

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Aim To evaluate whether renal length z‐scores predict renal dysfunction in children with a solitary functioning kidney (SFK). Methods In a single‐centre retrospective cohort of children with SFK, we correlated body mass index z‐scores, extracellular volume and lean body mass to renal length z‐scores. We grouped these z‐scores to other markers of renal dysfunction (proteinuria, hypertension, extracellular volume and abnormal estimated glomerular function rate [eGFR]) and analysed renal length z‐score with multivariate analysis, receiver‐operated characteristics (ROC) plots and Youden's index to determine an appropriate cut‐off. Results 111 children had a median follow‐up 5.08 years, eGFR 80.8 mL/min/1.73 m2, and age at last follow‐up 7.4 (3.8‐13.4 years). The median renal length z‐scores of those without any renal dysfunction (n = 37, 25.1%) were greater (+3.66, interquartile range 3.02‐4.47) than those with renal dysfunction (median 3.11, interquartile range 1.76‐4.11, P = .0107, Mann‐Whitney test). Using a cut‐off of z‐score of >+1.911, the odds ratio for having no renal dysfunction was 0.07 (95% CI 0.002‐0.459, P = .0010). However, accuracy of the renal length z‐score was poor (ROC curve 0.6488). Conclusion In this cohort of children with SKF, using the renal length z‐score as a biomarker of renal dysfunction at 7 years of age is not recommended.

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Section: Regression Analysismentioning

confidence: 99%

Renal length z‐score for the detection of dysfunction in children with solitary functioning kidney

et al. 2020

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“…Regarding pre Tx LUTD, we had 38 cases in refluxing graft group with LUTD in comparison to study done by Wang, Mary K., et al, [8] there was 12 cases of total 37 cases. We had median follow up time (range) was 5(1-11)y, while in another study, median (range) follow up time was 23.7 months (range 6.3-39.3) [5] .…”

Section: Discussionmentioning

confidence: 76%

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

El-Ghany

Gawad

Esmaeel

et al. 2020

Minia Journal of Medical Research

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Objective:The goal of this study was to evaluate pediatric post transplant vesicoureteral reflux (VUR) in terms of graft's Urinary Tract Infections (UTIs) episodes, graft outcome and survival in comparison to grafts that don't have reflux. Subjects and Methods: A total of 145 pediatric patients who underwent kidney transplantation at our transplantation unit between 2008 and January 2019 and suited our inclusion criteria were included in this retrospective cohort study and a voiding cystourethrography (VCUG) was done to them and categorized into main groups; group (A) refluxing graft group (n=66) and group (B) non refluxing graft group (n=79). Baseline donor and recipient demographic characteristics, post transplant serum creatinine level at different points, graft outcome, and UTIs were listed. Post transplantation (Tx) UTIs and graft outcome were compared between both groups. Glomerular Filtration Rate (GFR) was measured using Shwartz formula. Frequency-Volume Chart (FVC) and UroDynamic Study (UDS) were used to identify Lower urinary Tract (LUT) condition and helped us regarding decision making in management of graft VUR. Results: Mean ±SD age at time of Tx was 8.7±3.4y in group A versus 8.9±2.8y in group B, P value=0.667. Regarding sex, 46 patients (69.7%) were male in group A, while 56(70.9%) were male in group B, p value = 0.876. UTI occurrence was similar between groups {40(60.6%) patients in group A versus 49 (62%) patients in group B, P value=0.861 but UTIs episodes (more than 3 episode per year) was 20 (30.3%) patients in group A versus 1(1.3%) patient, P value =0.001. Both groups were similar in terms of 5-year (100% versus 98.5%), and 10-year (76.2% versus 84.7%) graft survival. Conclusions: There was no difference between refluxing and non refluxing graft in terms of UTIs occurrence, graft function and survival. Frequency of UTI episodes was more in the refluxing graft like any native kidney primary VUR.

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“…Other groups have described management of transplant reflux by intervening at the level of the bladder with Deflux injection, or reimplantation of the transplant ureter 6,7,10,11,14,15 . Unique to our institution, transplant reflux has been managed most commonly with pyeloureterostomy or ureteroureterostomy of the transplant kidney/ureter to the native ureter ( n = 8; 57%).…”

Section: Discussionmentioning

confidence: 99%

“…This approach has not been well described in the literature. 6,7,10,11,14,15 In this retrospective series, we evaluated pediatric patients who underwent renal transplantation and developed ureteral complications, requiring surgical intervention. We specifically aimed to describe the methodology of ureteral reconstruction based on patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

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The utility of native ureter in the management of ureteral complications in children after renal transplantation

Serrell

O’Kelly

et al. 2021

Pediatric Transplantation

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Background: Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable.Methods: With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications.Results: Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant.Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12][13][14][15][16][17][18][19]). Conclusions:Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.

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Renal function outcomes in pediatric patients with symptomatic reflux into the transplanted kidney treated with redo ureteroneocystostomy

Cited by 7 publications

References 18 publications

Renal length z‐score for the detection of dysfunction in children with solitary functioning kidney

Renal length z‐score for the detection of dysfunction in children with solitary functioning kidney

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

The utility of native ureter in the management of ureteral complications in children after renal transplantation

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