Does pre-transplantation antireflux surgery eliminate post-renal transplantation pyelonephritis in children?
OBJECTIVE
Antireflux surgery for VUR before renal transplantation decreases the risk of post-kidney transplant UTI in pediatric patients with primary vesicoureteral reflux. We studied the risk of post-kidney transplant UTI in patients with or without surgical correction of VUR before transplantation compared to patients without VUR.


METHODS
We compared 12 patients who had VUR corrected before transplantation (group 1) to 17 patients with VUR who did not undergo antireflux surgery before transplantation (group 2) and 36 patients undergoing renal transplantation without VUR (group 3). A total of 10 patients in group 1 (83.3%) and 10 in group 2 (58.8%) had high grade VUR.


RESULTS
Eight patients in group 1 (66.7%), 6 in group 2 (35.3%) and 33 in group 3 (91.7%) remained free of febrile UTI during followup (p = 0.00). Among patients with high grade VUR 6 in group 1 and 1 in group 2 remained UTI-free (p = 0.02). A total of 33 patients in the control group (91.7%) remained free of febrile UTI, an incidence that was significantly lower compared to group 1 (p = 0.03) and group 2 (p = 0.00). Of the patients with high grade VUR 3 in group 1 (30%) and 4 in group 2 (40%) experienced recurrent febrile UTIs (p = 0.64).


CONCLUSIONS
Even after surgical correction of VUR before transplantation the frequency of febrile UTI remained higher than that in kidney transplant recipients without VUR. In cases of high grade VUR reimplantation before renal transplantation decreased the rate of febrile UTI but it was still higher than the level of risk in the control group.
Basiri
A
A
Urology and Nephrology Research Center, Labbafi Nejad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran. abbasbasiri@hotmail.com
Otookesh
H
H
Simforoosh
N
N
Hosseini
R
R
Hosseini-Moghaddam
S M M
SM
Sharifian
M
M
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011300:Preoperative Care; D011704:Pyelonephritis / Q000209:etiology* / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*