Renal Transplantation in Children with Obstructive Uropathy

Abstract

The outcome of renal transplantation was examined in 52 pediatric patients (mean age 13 years) whose primary renal disease was obstructive uropathy. The bladder was used at transplantation in 45 allograft recipients, 39 of whom had had a previous lower urinary tract operation or bladder defunctionalization. An ileal loop was used in 7 recipients. The 52 patients received 73 renal allografts from 58 cadaver and 15 live-related donors. Presently, 40 patients (77 per cent) have functioning allografts, 4 have returned to dialysis and 8 (15 per cent) have died. The results indicate that the outcome of renal transplantation in patients with obstructive uropathy is similar to that of other transplant recipients. Damaged and defunctionalized bladders may be used successfully in most cases. If necessary an ileal conduit is an effective alternative. Post-transplant urologic complications occur with increased frequency but with appropriate management allograft salvage and patient survival are excellent.

Increased Urologic Complications in Children After Kidney Transplants for Obstructive and Reflux Uropathy

“…In our study, the patients with obstructive and reflux uropathy had a higher incidence of urinary obstruction, urinary reflux, urolithiasis and UTIs, as compared with matched controls. Our 45% incidence of urologic complications is higher than the 19-35% reported in the literature (5,9,12,17,21,27,28). We suspect this difference is, in part, due to our longer follow-up period and our use of a detailed data base.…”

Renal Transplantation in Children

“…Excellent results utilizing a previously defunctionalized bladder for transplantation have been noted. If the bladder is not usable, an ileal loop can be created prior to transplantation for use at the time of transplantation [10], Lastly, if the child has a neurogenic bladder, self-catheterization is a viable alternative, after transplantation, to a diversionary procedure.…”

Choosing a Treatment Modality for the Infant, Child and Adolescent with Endstage Renal Disease

“…The presence of an abnormal lower uri nary tract is not a contraindication to trans plantation [37], If the bladder is defunctionalized because of prior diversionary proce dures, assiduous attempts should be made to use it for transplantation. Excellent results utilizing a previously defunctionalized blad der for transplantation have been noted [20].…”

“…Excellent results utilizing a previously defunctionalized blad der for transplantation have been noted [20]. If the bladder is not usable an ileal loop can be created for use at the time of transplanta tions [37]. Lastly, if the child had a neuro genic bladder, self-catheterization is a viable alternative posttransplant to a diversionary procedure.…”