title: Trends in Renal Transplantation Rates in Patients with Congenital Urinary Tract Disorders.
abstract: OBJECTIVE
  Improved bladder and renal management benefit patients with congenital uropathy and congenital pediatric kidney disease. This may translate to delayed initial renal transplantation in these patients, and improved graft and patient survival. Our primary study purpose was to determine whether patients with congenital uropathy and congenital pediatric kidney disease have demonstrated later time to first transplantation and/or graft survival.
  
  
  METHODS
  SRTR (Scientific Registry of Transplant Recipients) was analyzed for first renal transplant and survival data in patients with congenital uropathy and congenital pediatric kidney disease from 1996 to 2012. Congenital uropathy included chronic pyelonephritis/reflux, prune belly syndrome and congenital obstructive uropathy. Congenital pediatric kidney disease included polycystic kidney disease, hypoplasia, dysplasia, dysgenesis, agenesis and familial nephropathy.
  
  
  RESULTS
  A total of 7,088 patients with congenital uropathy and 24,315 with congenital pediatric kidney disease received a first renal transplant from 1996 to 2012. A significant shift was seen in both groups toward older age at initial renal transplantation in those 18 through 64 years old. In the congenital uropathy group this effect was most facilitated by decreased renal transplantion in patients between 18 and 35 years old (38% in 1996 vs 26% in 2012). The congenital pediatric kidney disease group showed a substantial decrease in patients who were 35 to 49 years old (from 39% to 29%). At 10-year followup the congenital uropathy group showed better graft and patient survival than the congenital pediatric kidney disease group. However, aged matched comparison revealed comparable survival rates in the 2 groups.
  
  
  CONCLUSIONS
  Analysis of trends in the last 14 years demonstrated that patients with both lower and upper tract congenital anomalies experienced delayed time to the first renal transplant. Furthermore, patients had similar age matched graft and patient survival whether the primary source of renal demise was the congenital lower or upper tract. These findings may indicate that improved urological and nephrological care are promoting renal preservation in both groups.
authors.affiliation: Department of Urology, Cleveland Clinic, Cleveland, Ohio. Electronic address: hermanbagga@gmail.com.
authors.forename: Herman S
authors.initials: HS
authors.lastname: Bagga
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Songhua
authors.initials: S
authors.lastname: Lin
authors.affiliation: Transplant Unit, Department of Paediatric Urology, Nottingham Children's Hospital, Nottingham, United Kingdom.
authors.forename: Alun
authors.initials: A
authors.lastname: Williams
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jesse
authors.initials: J
authors.lastname: Schold
authors.affiliation: Case Western Reserve University of Medicine, Cleveland, Ohio.
authors.forename: Nathan
authors.initials: N
authors.lastname: Chertack
authors.affiliation: Department of Urology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Goldfarb
authors.affiliation: Department of Urology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hadley
authors.initials: H
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000151:congenital* / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data* / Q000639:trends*; D008875:Middle Aged; D013997:Time Factors; D014570:Urologic Diseases / Q000150:complications / Q000151:congenital / Q000601:surgery; D055815:Young Adult
keywords: congenital; graft survival; kidney diseases; kidney transplantation; mortality