title: Malformative uropathies and kidney transplantation.
abstract: BACKGROUND
  Malformative uropathies are a frequent cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Medical management of urinary tract infections and advances in surgical reconstruction procedures resulted in good outcomes of kidney transplantation among these patients. The aim of this article was to describe the epidemiological profiles and outcomes of patients who underwent transplantation for ESRD related to malformative uropathies.
  
  
  METHODS
  Among 493 kidney recipients at our center from 1986 to 2009, 47 had malformative uropathies as the cause of ESRD. We retrospectively studied the incidence of acute rejection episodes, acute tubular necrosis, as well as patient and graft survivals, comparing these results to those observed in patients without malformative uropathies using chi-square tests for qualitative parameters and nonpaired Student t tests for continuous variables. Log-rank tests were used for comparisons of survival curves.
  
  
  RESULTS
  The 47 patients, representing 9.53% of our kidney transplant recipients, included 27 men and 20 women (sex ratio=1.35) with an overall mean age of 27.6±9.1 years (range, 10-49). The common etiology was vesico-ureteral reflux (78.7%). Hemodialysis was the main RRT modality (68%) with a median duration of 41 months. Also, 82.9% of patients received transplants from living donors. Acute tubular necrosis occurred in 4 of these (8.5%) versus 22.06% of the other patients (P=.03). Acute rejection episodes were observed in 13 of these patients (27.6%) versus 23.1% of the other patients (P=not significant [NS]). After a cumulative follow-up period of 3744 months (median, 41.8 months), 5 patients had died (1.6 death/y/100 patients) and 5 had lost their allografts and returned to dialysis (1.6 case/y/100 patients). Graft survival rates at 1, 5, and 10 years were 97.8%, 93.2%, and 79.9%, which were comparable with 95.9%, 87.6%, and 78.9% among the other patients, respectively (P=NS). Patient survival rates at 1, 5, and 10 years were 100%, 88.5%, and 82.6% versus 96%, 87.6%, and 79.6%, respectively (P=NS).
  
  
  CONCLUSIONS
  Kidney transplantation in patients with malformative uropathies is increasingly frequent. The incidence of acute rejection episodes as well as patient and graft survivals were comparable with those of subjects without malformative uropathies.
authors: Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia. mejid66@yahoo.fr
authors: M
authors: M
authors: Ounissi
authors: T
authors: T
authors: Gargah
authors: M M
authors: MM
authors: Bacha
authors: K
authors: K
authors: Boubaker
authors: H
authors: H
authors: Hedri
authors: E
authors: E
authors: Abderrahim
authors: A
authors: A
authors: Derouich
authors: R B
authors: RB
authors: Slama
authors: M
authors: M
authors: Chebil
authors: T B
authors: TB
authors: Abdallah
authors: A
authors: A
authors: Kheder
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009336:Necrosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000401:mortality / Q000628:therapy*