Introduction: Vesicoureteral reflux (VUR) is an important complication after renal transplant and it may cause recurrent urinary tract infection (UTI), acute pyelonephritis, even deteriorate renal function in long term effects. Minimal invasive endoscopic surgery is an efficient management choice with reported recurrence rate of 31-90%. We are interested about the recurrent VUR after the endoscopic treatment for post renal transplant VUR.
Materials and Methods: From 2014 to 2019, total 18 patient received endoscopic Deflux injection therapy for their symptomatic de novo VUR after renal transplantation. All patient had functioning graft kidney when diagnosed. We analyze the patient age of renal transplant, VUR grading, pre- and post-injection serum creatinine level, UTI-associated admissions, endoscopic treatment time and Deflux injection amount, and urine analysis data. 
Results: Of all 18 collected patients, 16 patients received Deflux injection smoothly and the other 2 male patients requires antegrade guidewire assistance. Four patients had recurrence of their VUR at a mean time of 2 months after injection, all these 4 failed patients were female gender. In addition, we found that the urine white blood cell counts (uWBC) before injection was significantly higher in the failure group (357.0±143.9 versus 122.7±184.6, p=0.0032). Logistic regression showed uWBC was an independent risk factor of VUR recurrence (p=0.009). 
Conclusions: Endoscopic Deflux injection is an alternative treatment for post-transplant VUR. In our series higher uWBC was the risk factor of VUR recurrence.