title: Long-Term Outcomes of Kidney Transplant Recipients with Bladder Dysfunction: A Single-Center Study.
abstract: BACKGROUND
  Long-term outcomes of kidney transplantation recipients with bladder dysfunction or prior bladder surgery are not well characterized.
  
  
  METHODS
  Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. We found that 1652 recipients had normal bladder function, 80 had bladder dysfunction, and 21 had bladder substitute or urinary diversion. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes.
  
  
  RESULTS
  Kaplan-Meier graft survival (p=.11) and patient survival (p=.18) were lower in recipients with bladder surgery but not statistically significant. Multivariate analysis demonstrated inferior graft survival (HR 3.57, 95% CI 1.06-12.1, p =0.04) and a trend towards inferior patient survival (HR 3.19, 95% CI .71-14.5, p=0.13) in reci-pients with bladder surgery. The major cause of graft failure was chronic rejection for normal function (17.1%) and bladder dysfunction (28.5%), and infection for bladder surgery (28.5%). Post-operative urinary infectious and surgical complications were higher in recipients with bladder dysfunction (35%) and substitutes (52.3%) compared with normal function (12.8%).
  
  
  CONCLUSIONS
  Kidney transplant recipients with prior bladder surgery have an increased risk of graft failure and an increased risk of infectious urinary complications. These risks should be considered in recipient selection and post-transplant management.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dushyanth
authors.initials: D
authors.lastname: Srinivasan
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Kapeles
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kori
authors.initials: K
authors.lastname: Bradley
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000601:surgery