Vesicoureteral reflux after kidney transplantation in children

Ranchin, Bruno; Chapuis, François; Dawhara, M; Cantérino, I; Hadj‐Aïssa, Aoumeur; Saïd, Marie-Hélène; Parchoux, B; Dubourg, Laurence; Pouillaude, J. M.; Floret, D.; Martín, Xavier; Cochat, Pierre

doi:10.1093/ndt/15.11.1852

Cited by 78 publications

(73 citation statements)

References 20 publications

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“…The ureteroneocystotomy continues to heal for at least 6-8 weeks after transplantation, and reflux identified early postoperative may later disappear or reappear. In light of the earlier finding that VUR incidence may change with time after surgery and considering that the ureteroneocystotomy continues to heal for at least 6-8 weeks after transplantation, one may argue that VUR identified early after transplantation could disappear or reappear during subsequent follow-up (40,41). Further limitations are that the recording of UTIs was limited to the first year after renal transplantation and that for some of the parameters tested, including death-censored graft survival for cases with grade III and IV reflux, the study might have been underpowered.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Value of Routine Voiding Cystourethrography After Renal Transplantation

Margreiter

Györi

Böhmig

et al. 2013

American Journal of Transplantation

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“…The role of reflux into the graft kidney as a risk factor for post-KTx UTI could not be determined because MCUG is not routinely performed for all recipients of kidney graft and therefore not all children with postKTx UTI had had an MCUG. Reflux into the graft kidney has been consistently identified as a risk factor for post-KTx UTI [21,22]. Graft function was defined using eGFR; however, creatinine-based eGFR as a marker of kidney function still enjoys several advantages, such as the ease of measurement, and is still commonly used as such in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Urinary tract infection following kidney transplantation: frequency, risk factors and graft function

2011

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The aim of this study was to determine the proportion of children who develop urinary tract infection (UTI) after kidney transplantation (KTx) and to identify the factors associated with UTI and its impact on graft function. To this end, we undertook a chart review of children who underwent KTx at Red Cross Children's Hospital between January 2003 and December 2009 and were followed-up for at least 6 months after transplantation. Sixty-two children (53.2% males) were followed-up for a mean (standard deviation) period of 36.9 (19.7) months. Mean age at transplantation was 10.0 (4.6) years. Twenty-five (40.3%) children had 89 UTI episodes during the study period, equivalent to 0.94 UTI episodes per one patient-year of follow-up. Acute pyelonephritis occurred in 17 (27.4%) children; another 17 (27.4%) had multiple post-KTx UTI. Klebsiella (40.0%) and Escherichia (28.0%) were the commonest organisms. Those with post-KTx UTI were, at transplantation, younger (8.3 vs. 11.2 years; p = 0.017), had lower urinary tract abnormality (LUTA) (13 vs. 1; p = 0.000) and had pre-KTx UTI (13 vs. 5; p = 0.001). Multivariate analysis revealed that only age <5 years at transplantation and LUTA remained significant and that UTI KTx was not associated with worsening graft function. UTI is common after post-KTx. Among our patient cohort, younger age and LUTA were risk factors, but UTI did not affect graft function.

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“…Vesico-ureteral reflux (VUR) is common in the renal transplant recipient and children with VUR have an increased risk of acute pyelonephritis (26) and allograft scarring (27). In adults, UTI is not more common in patients with VUR (28 (13), Memikoglu (14), Pelle (4) and DiCocco (56).…”

Section: Risk Factorsmentioning

confidence: 99%

Urinary Tract Infections in Solid Organ Transplant Recipients

Rice

Safdar

2009

American Journal of Transplantation

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Epidemiology Urinary tract infection (UTI) is the most common infection in the renal Enterobacter and other organisms (group B streptococci, and Gardnerella vaginalis) also occurring (Figure 1) (4,(10)(11)(12)(13)(14) UTI and pyelonephritis (24,25). Vesico-ureteral reflux (VUR) majority of pyelonephritis isolates from immunosuppressed patients (17,18). In addition, a subset of O antigen serotypes are present on the majority (80%) of E. coli isolates from patients with UTI (11,19). Although most studies document a decreased prevalence of virulence factors expressed by uropathogenic E. coli from compromised hosts, likely reflecting the weaker barriers to infection in this population (17), a recent report suggests that unique patterns of uropathogenic of O:H serotypes and P fimbriae adherence factor among E. coli isolates from renal transplant patients with UTI (20). Risk factors

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Vesicoureteral reflux after kidney transplantation in children

Abstract: VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.

Cited by 78 publications

References 20 publications

Value of Routine Voiding Cystourethrography After Renal Transplantation

Value of Routine Voiding Cystourethrography After Renal Transplantation

Urinary tract infection following kidney transplantation: frequency, risk factors and graft function

Urinary Tract Infections in Solid Organ Transplant Recipients

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