Comparison of renal transplantation outcomes in children with and without bladder dysfunction. A customized approach equals the difference.
OBJECTIVE
We examined the development of urological abnormalities in a group of pediatric renal transplant recipients.


METHODS
We reviewed 211 patients younger than 19 years who underwent 226 renal transplants. Three groups of patients were studied-136 children with end stage renal disease due to a nonurological cause (group 1), 56 children with a urological disorder but with an adequate bladder (group 2a) and 19 children with lower urinary tract dysfunction and/or inadequate bladder drainage (group 2b). A total of 15 children in group 2b underwent bladder augmentation (ureterocystoplasty in 6, enterocystoplasty in 9), 2 underwent continent urinary diversion, 1 underwent autoaugmentation and 1 underwent a Mitrofanoff procedure at the bladder for easier drainage. Kidney transplantation was performed in the classic manner by extraperitoneal access, and whenever possible the ureter was reimplanted using an antireflux procedure.


RESULTS
At a mean followup of 75 months 13 children had died, 59 grafts were lost and 15 children had received a second transplant. Two patients in group 2a required a complementary urological procedure to preserve renal function (1 enterocystoplasty, 1 vesicostomy). A total of 12 major surgical complications occurred in 226 kidney transplants (5.3%), with a similar incidence in all groups. The overall graft survival at 5 years was 75%, 74% and 84%, respectively, in groups 1, 2a and 2b.


CONCLUSIONS
With individualized treatment children with severely inferior lower urinary tract function may undergo renal transplantation with a safe and adequate outcome.
Nahas
William C
WC
Department of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Antonopoulos
Ioannis M
IM
Piovesan
Affonso C
AC
Pereira
Lilian M
LM
Kanashiro
Hideki
H
David-Neto
Elias
E
Ianhez
Luiz E
LE
Srougi
Miguel
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000601:surgery; D014555:Urination Disorders / Q000209:etiology / Q000601:surgery; D013520:Urologic Surgical Procedures