title: Long-term followup of cadaveric renal transplantation in patients with spina bifida.
abstract: OBJECTIVE
  Access related problems in hemodialysis and peritoneal dialysis are increased in cases of spina bifida due to vascular and body habitus limitations. Reports of renal transplantation in this patient group are exceedingly rare. We report long-term followup data on cadaveric renal transplantation for end stage renal failure in cases of spina bifida.
  
  
  METHODS
  Between February 1986 and April 2000, 17 cadaveric renal transplants were performed in 11 females and 5 males with spina bifida. Mean age at transplantation was 20.2 years (range 10 to 35). Of the patients 11 were wheelchair bound and 5 were independently mobile. Before transplantation surgical management of the urological tract included clean intermittent self-catheterization in 3 cases, enterocystoplasty and clean intermittent self-catheterization in 8, and ileal conduit urinary diversion in 5. A total of 14 patients were on renal replacement therapy before receiving the graft. Cyclosporine based triple therapy was administered to maintain immunosuppression in all cases and antithymocytic globulin was given for induction in 7.
  
  
  RESULTS
  Six grafts have failed, including 1 in a patient who underwent successful re-transplantation. Median graft survival was 7.23 years. Two patients died after graft nephrectomy. At a mean followup of 52.8 months (range 1 month to 14 years) 11 of 17 grafts are functioning with a mean serum creatinine of 112.7 +/- 29.4 mmol./l.
  
  
  CONCLUSIONS
  These data demonstrate the feasibility of cadaveric renal transplantation in patients with spina bifida and end stage renal failure. We currently recommend that these patients should not be deprived of the benefits of renal transplantation.
authors.affiliation: Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Power
authors.forename: Kiaran J
authors.initials: KJ
authors.lastname: O'Malley
authors.forename: Dilly M
authors.initials: DM
authors.lastname: Little
authors.forename: Mary G
authors.initials: MG
authors.lastname: Donovan
authors.forename: Tom A
authors.initials: TA
authors.lastname: Creagh
authors.forename: Denis M
authors.initials: DM
authors.lastname: Murphy
authors.forename: David P
authors.initials: DP
authors.lastname: Hickey
mesh_terms: D000293:Adolescent; D000328:Adult; D002102:Cadaver; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D016135:Spinal Dysraphism / Q000150:complications*; D016896:Treatment Outcome