Renal Transplantation in Patients with Lower Urinary Tract Dysfunction

Abstract

INTRODUCTION & OBJECTIVES: In pediatric population, 40% of ESRD is secondary to uropathologies and LUTD is most common urologic abnormality. Renal transplantation in patients with LUTD is considered high risk due to potential early and late complication and graft loss risk. The aim of this retrospective study is to investigate the outcome of renal transplantation in patients who developed ESRD secondary to LUTD. MATERIAL & METHODS: We retrospectively reviewed the outcomes of 31 patients with ESRD secondary to LUTDand renal transplantation between April 1998 and April 2011. There were 23 males and 8 females with a mean age of 15 ± 4. Etiology of ESRD was neurogenic bladder in 17, posterior urethral valve in 12 and voiding dysfunction in 2 of the patients. Eighteen patients received kidney from a living donor while thirteen received from a deceased-donor. Among those, 10 patients had augmentation cystoplasty surgery prior to the transplantation. All patients were evaluated by cystometry prior to transplantation. Initially all of them were managed by triple immunosuppressive medications consisting of a calcineurin inhibitor, an anti-proliferative agent and corticosteroid. RESULTS: Mean creatinin level at the last visit was 1.5 ± 0.4 mg/dl within a follow up of mean 43 ± 13 months (4-133 months). Graft failure developed in 3 patients due to pneumonia, FSGS nephropathy and chronic allograft injury. Surgical complications were observed in 2 patients. One urine leak and ureteral stricture treated with percutaneous antegrade double-J stent placement, DJS encrustation treted with percutaneous nephrolithotomy. Clean intermittent catheterization was continued in 17 patients. Among them at least one urinary tract infection, that required hospitalization, developed in 13 of 17 patients, albeit all of the patients with augmented bladder. Graft and patients survival at 5th year was 91% and 100%respectively. CONCLUSIONS: All patients with severe LUTD and ESRD should be investigated as renal transplantation candidates and bladder must be rehabilitated. With careful patient selection, preoperative evaluation, and close post operative monitoring, renal transplantation can be performed safely. Higher risk of urinary tract infection, stone diseases, metabolic bone complications and malignancy should be always kept in mind in patients with bladder augmentation and kidney transplantation.