title: Does bladder augmentation negatively affect renal transplant outcome in posterior urethral valve patients?
abstract: OBJECTIVE
  Although renal transplant (RT) is a safe and effective treatment for end-stage renal disease, the outcome of RT has been mixed for posterior urethral valve (PUV) patients. In addition, some PUV patients need an augmentation cystoplasty (AC), which may negatively affect their RT outcome. The aim of this study is to compare RT outcome between PUV children with and without AC.
  
  
  METHODS
  Between 1985 and 2012 a total of 309 children received 369 RTs at our institution. Among these patients, 36 were had classified as having PUV. Of these, 12 underwent an AC before RT (AC group) and 24 did not (controls). Data, including age at transplant, allograft source, urological complications, urinary tract infection (UTI) incidence, the presence of vesicoureteral reflux (VUR), and patient and graft survival, were compared between groups.
  
  
  RESULTS
  Mean age at RT and mean follow-up were 7.6 versus 7.9 years and 8.9 versus 7.9 years in the AC group and in the control group, respectively (not significant [NS]). Allografts were from living donors in 50% of the AC group and in 41.6% of the controls (NS). The rate of UTI was 0.02 UTI/patient/year and 0.004 UTI/patient/year in the AC and control group, respectively (p = 0.001). Of the nine patients with UTI in the augmented group, five (55.5%) had VUR, while 5/8 (62.5%) patients in the control group with UTI had VUR. All patients with VUR in either group had UTIs previously. Of the five AC patients with more than three UTIs, two (40%) were non-compliant with clean intermittent catheterization (CIC), and UTI incidence was not associated with either a Mitrofanoff conduit or the urethra being used for CIC. Graft function at the end of study was 87.8 ± 40.5 ml/min/m(2) in the AC group and 88.17 ± 28.20 ml/min/m(2) in the control group (NS). The 10-year graft survival rate was 100% in AC group and 84.8% in controls. Two patients in the AC group lost their grafts (mean follow-up 13.3 ± 0.8 years) and five in the control group (mean follow-up 7.1 ± 4.7 years).
  
  
  CONCLUSIONS
  Bladder augmentation does not negatively affect renal outcome in PUV patients undergoing transplantation. However, recurrent UTIs are more frequent in transplanted PUV patients with an AC than in those without AC, and they are generally related to non-compliance with CIC or the presence of VUR but, mostly, they will not result in impaired graft function.
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain. Electronic address: plpuro@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: López Pereira
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Espinosa
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Martínez Urrutia
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Lobato
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Departments of Paediatric Urology and Paediatric Nephrology, University Hospital "La Paz", P° de la Castellana 261, Madrid 28046, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Jaureguízar
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
keywords: Bladder augmentation; Kidney transplantation; Posterior urethral valves