title: Renal transplantation in children with lower urinary tract dysfunction of different origin: a single-center experience.
abstract: BACKGROUND
  Renal transplantation in patients with lower urinary tract dysfunction (LUTD) of various origins is a challenging issue in the field of pediatric transplantation. We report our single-center experience to evaluate patient and graft survivals as well as the risks of the surgery and immunosuppressive therapy.
  
  
  METHODS
  Among 70 pediatric transplant patients, 11 displayed severe LUTD. Videourodynamic tests were performed on all patients preoperatively as well as postoperatively if required. The cause of urologic disorders were neurogenic bladder (n = 5) and urethral valves (n = 6). Clean intermittent catheterization (CIC) was needed in six patients to empty the bladder. To achieve a low-pressure reservoir with adequate capacity pretransplantation augmentation ileocystoplasty was created in four patients and gastrocystoplasty in one patient. Three of the patients received kidneys from cadaveric and eight from living donors. All patients were treated with calcineurin-based immunosuppressive therapy.
  
  
  RESULTS
  The mean age at transplantation was 15 +/- 4.7 years. The median follow-up after transplantation was 36 months (6 to 62 months). At their last visit the median creatinine level was 0.95 mg/dL (0.8 to 2.4 mg/dL). Three patients had recurrent symptomatic urinary tract infections who had augmented bladder on CIC. One patient with ileocystoplasty who developed urinary leak and ureteral stricture in the early postoperative period was treated by an antegrade J stent.
  
  
  CONCLUSIONS
  Severe LUTD carried high risks for the grafted kidney. However, our data suggested that renal transplantation is a safe and effective treatment modality, if the underlying urologic diseases properly managed during the transplantation course. Since surgery and follow-up is more complicated, patient compliance and experience of transplantation team have significant impacts on outcomes.
authors.affiliation: Department of Pediatrics Nephrology Unit, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Bilginer
authors.forename: F T
authors.initials: FT
authors.lastname: Aki
authors.forename: R
authors.initials: R
authors.lastname: Topaloglu
authors.forename: S
authors.initials: S
authors.lastname: Tekgul
authors.forename: E
authors.initials: E
authors.lastname: Demirkaya
authors.forename: A
authors.initials: A
authors.lastname: Düzova
authors.forename: N
authors.initials: N
authors.lastname: Besbas
authors.forename: S
authors.initials: S
authors.lastname: Ozen
authors.forename: I
authors.initials: I
authors.lastname: Erkan
authors.forename: A
authors.initials: A
authors.lastname: Bakkaloglu
authors.forename: M
authors.initials: M
authors.lastname: Bakkaloglu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014546:Urinary Catheterization; D014570:Urologic Diseases / Q000145:classification / Q000150:complications / Q000209:etiology / Q000601:surgery*