Long-term results of pediatric renal transplantation into a dysfunctional lower urinary tract.
BACKGROUND
The authors reviewed their long-term experience with pediatric renal transplantation into a dysfunctional lower urinary tract to evaluate the results of contemporary lower urinary tract evaluation and management on graft survival and function.


METHODS
Between 1990 and 1996, 21 renal transplants were performed in 20 children with dysfunctional lower urinary tracts and 61 transplants were performed in 61 patients with normal lower urinary tracts. The minimum follow-up was 36 months (mean, 62.0 +/- 19.6 months). The cause of lower urinary tract dysfunction included posterior urethral valves (n=13), prune belly syndrome (n=4), meningomyelocele (n=2), and urogenital sinus abnormality (n=1). Urodynamics were performed on all children with dysfunctional lower urinary tracts. Using these perioperative assessments, lower tract management strategies were devised, including timed voiding alone (n=6), clean intermittent catheterization (n=8), bladder augmentation (n=4), and supravesical urinary diversion (n=2).


RESULTS
Overall 5-year actuarial patient and graft survival rates were 100% versus 95% (P=not significant [NS]) and 83% versus 69% in the dysfunctional and normal urinary tract groups (P=NS), respectively. Mean serum creatinine levels in dysfunctional and normal urinary tract patients with functioning grafts at 3 years were 1.3 +/- 0.5 and 1.3 +/- 0.7 mg/dL, respectively (P=NS). However, 35% of patients with a dysfunctional lower urinary tract experienced urologic complications.


CONCLUSIONS
Pediatric renal transplantation into a dysfunctional lower urinary tract yields outcomes comparable to transplantation into the normal lower urinary tract. Because of the high urologic complication rates, careful surveillance of lower urinary tract function by urodynamic evaluation is essential to optimize these outcomes.
Luke
Patrick P W
PP
Department of Urology, University of Pittsburgh Medical Center, Childrens Hospital of Pittsburgh, Pittsburgh, PA, USA. patrick.luke@lhsc.on.ca
Herz
Daniel B
DB
Bellinger
Mark F
MF
Chakrabarti
Pradip
P
Vivas
Carlos A
CA
Scantlebury
Velma P
VP
Hakala
Thomas R
TR
Jevnikar
Anthony M
AM
Jain
Ashok
A
Shapiro
Ron
R
Jordan
Mark L
ML
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000150:complications*