title: Kidney transplantation in children with urinary diversion or bladder augmentation.
abstract: OBJECTIVE
  Urinary tract anomalies or dysfunction leaves the bladder unsuitable for urine drainage in a significant proportion of children presenting for kidney transplantation. We reviewed a multi-institutional experience to determine the ramifications of kidney transplantation in children with bladder augmentation or urinary diversion.
  
  
  METHODS
  During a 28-year period 18 boys and 12 girls 1.7 to 18 years old (mean age 12.1) received 31 kidney transplants. Cause of end stage renal disease was renal dysplasia in 8 cases, posterior urethral valves in 5, obstructive uropathy in 5, neurogenic bladder/chronic pyelonephritis in 4, spina bifida/chronic pyelonephritis in 3, prune belly syndrome in 3 and reflux in 2.
  
  
  RESULTS
  Of the patients 17 had augmented bladder (ileum 9, ureter 5, sigmoid 2 and stomach 1), 12 had incontinent urinary conduits (8 ileum, 6 colon) and 1 had a continent urinary reservoir. Surgical complications included 1 case each of stomal stenosis, stomal prolapse, renal artery stenosis, urine leak, enterovesical fistula and wound dehiscence. Medical complications included urinary tract infection in 21 cases and metabolic acidosis in 5. A bladder stone developed in 1 patient. There was no correlation between the incidence of symptomatic urinary tract infections and type of urinary drainage. Acidosis was more common in patients with augmented bladder (4 of 17 versus 1 of 14) but there was no correlation between the bowel segment used and the occurrence of acidosis. Graft survival was 90% at 1 year, 78% at 5 years and 60% at 10 years. Etiology of graft loss included chronic rejection in 6 cases, noncompliance in 4 and acute rejection in 1. There were no deaths.
  
  
  CONCLUSIONS
  Drainage of transplanted kidneys into an augmented bladder or urinary conduit is an appropriate management strategy when the native bladder is unsuitable or absent. Patients with kidney transplants drained into augmented bladder or urinary conduit are at increased risk for urine infection. Graft survival is not adversely affected compared to historical controls when a kidney transplant is drained into a urinary conduit or augmented bladder.
authors.affiliation: Department of Urology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Hatch
authors.forename: M A
authors.initials: MA
authors.lastname: Koyle
authors.forename: L S
authors.initials: LS
authors.lastname: Baskin
authors.forename: M R
authors.initials: MR
authors.lastname: Zaontz
authors.forename: M W
authors.initials: MW
authors.lastname: Burns
authors.forename: W F
authors.initials: WF
authors.lastname: Tarry
authors.forename: J M
authors.initials: JM
authors.lastname: Barry
authors.forename: P
authors.initials: P
authors.lastname: Belitsky
authors.forename: R J
authors.initials: RJ
authors.lastname: Taylor For
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion; D013520:Urologic Surgical Procedures