The modified Barry technique to prevent vesicoureteric reflux in paediatric renal transplant recipients: initial recipient outcomes.
OBJECTIVE
We present the initial clinical results of the 'modified Barry technique' for the prevention of VUR in paediatric renal transplant grafts. Ours is the only centre in the UK using this technique, as confirmed in a questionnaire developed in our department.


METHODS
We retrospectively analysed data of 15 paediatric renal transplant patients (operated June 2006-November 2009) who had their vesicoureteric anastomosis performed using the modified Barry technique with a 2-cm submucosal anti-reflux tunnel. The original Barry technique involved the creation of a 4-cm tunnel; this was modified by us to reduce the risk of ureteric stenosis.


RESULTS
At a median follow up of 23.7 months (6.3-39.4), the incidence of VUR was 7% (1/15). There was no evidence of postoperative urological complications, such as urinary leak, primary ureteric obstruction including anastomotic stricture/stenosis, transplant graft renal calculi and chronic rejection. At current follow up, graft and patient survival are 100%.


CONCLUSIONS
With the introduction of the modified Barry technique, the incidence of VUR in our series fell 10-fold to 7%, compared with our earlier study (P<0.0001), without any urological complications. Although the initial results are encouraging, larger patient numbers and longer follow up are required to validate this technique further.
Department of Renal Transplant, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. nikhilvasdev@doctors.org.uk
Nikhil
N
Vasdev
Malcolm G
MG
Coulthard
Heather
H
Lambert
Mike
M
Keir
Hugh
H
Wyrley-Birch
David
D
Rix
Naeem
N
Soomro
David
D
Talbot
D000293:Adolescent; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003559:Cystostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000517:prevention & control*