Kidney transplantation in pediatric patients with lower urinary tract dysfunction
Dorota Broniszczak-Czyszek1, Hor Ismail1, Katarzyna Pankowska- Woźniak1, Jacek Rubik2, Piotr Gastoł3, Marek Szymczak1, Ryszard Grenda2, Piotr Kaliciński1.
1Department of Pediatric Surgery and Organ Transplantation , Children’s Memorial Health Institute, Warsaw, Poland; 2Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, Warsaw, Poland; 3Department of Urology, Children’s Memorial Health Institute, Warsaw, Poland
Introduction: Approximately 30 % of children with end stage renal disease have lower urinary tract dysfunction which can have deleterious influence on kidney transplantation (KTx).
The aim of the study is to present single center long-term outcome of kidney transplantation in pediatric recipients with bladder dysfunction.
Material and Method: Between 2000 and 2018 there were 752 KTx performed in our center. Within them there were 545 KTx into normal bladder and 207 KTx in patients with bladder dysfunction (130 KTx into native dysfunctional bladder and 77 KTx into urinary diversion). Surgical complications rate, urinary tract infections rate and graft survival in groups of patients transplanted into normal bladder, dysfunctional bladder and urinary diversion were compared.
Results: Surgical complications were higher in group of recipients with dysfunctional bladder and urinary diversion in comparison to recipients with normal bladder (33% vs 28% vs 20%). Urinary tract infecions rate was significantly higher in groups of recipients with dysfunctional bladder and urinary diversion in comparison to recipients with normal bladder (57% vs 59% vs 18%). Graft loss was 18,5 % vs 9 % vs 17,9% in groups of recipients with dysfunctional bladder, urinary diversion and normal bladder respectively. The major cause of graft failure in each group was chronic rejection.
Conclusions: Kidney transplantation in children with lower urinary tract dysfunction and end-stage renal failure offers good long-term results. Urinary tract infections are the most common complications in these patients. The major cause of graft loss is chronic rejecion.