Incidence, predictors, and associated outcomes of prostatism after kidney transplantation.
OBJECTIVE
Renal transplantation is increasingly performed in elderly patients, and the incidence of benign prostatic hyperplasia (BPH) increases with age. Anuric males on dialysis may have occult BPH and not develop obstructive symptoms until urine flow is restored after transplantation. If left untreated, BPH poses a risk for numerous complications, including acute urinary retention (AUR), recurrent urinary tract infections (UTI), and renal failure. The authors hypothesized that incident BPH after renal transplantation would adversely affect allograft survival.


METHODS
Medicare claims for BPH, AUR, UTI, and prostate resection procedures (transurethral resection of the prostate; TURP) were assessed in a retrospective cohort of 23,622 adult male Medicare primary renal transplant recipients in the United States Renal Data System database who received transplants from 1 January 2000 to 31 July 2005 and followed through 31 December 2005.


RESULTS
The 3-yr incidence of BPH post-transplant was 9.7%. The incidences of AUR, UTI, and TURP after BPH diagnosis (up to 3 yr posttransplant) were 10.3%, 6.5%, and 7.3% respectively, and each was significantly associated with BPH. Cox regression analysis showed that recipient age per year, later year of transplant, and dialysis vintage were associated with incident BPH. Using Cox nonproportional hazards regression, BPH was significantly associated with renal allograft loss (including death).


CONCLUSIONS
BPH is common in males after renal transplant and is independently associated with AUR, UTI, and graft loss. It is unknown whether treatment of BPH, either medical or surgical, attenuates these risks.
Hurst
Frank P
FP
Department of Nephrology, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307, USA. frank.hurst@us.army.mil
Neff
Robert T
RT
Falta
Edward M
EM
Jindal
Rahul M
RM
Lentine
Krista L
KL
Swanson
John S
JS
Agodoa
Lawrence Y
LY
Abbott
Kevin C
KC
D000328:Adult; D000367:Age Factors; D000368:Aged; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016016:Proportional Hazards Models; D011470:Prostatic Hyperplasia / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D053448:Prostatism / Q000150:complications / Q000209:etiology* / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology