title: Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation.
abstract: To evaluate the risk for urological complications after kidney transplantation at a single medical center in Japan.
  
  
  
  In the present study, 408 kidney recipients (255 men, 153 women) were enrolled. There were 349 living and 59 deceased donors. The average age of the recipients was 42.5 ± 13.5 years, and the average pretransplant dialysis period was 71.8 ± 88.2 months. Ureteroneocystostomy was carried out on 347 patients, and ureteroureterostomy on 61 patients. We investigated the relationship between pretransplant duration of dialysis and bladder capacity, and examined the risk factors for urological complication. We also evaluated the incidence of vesicoureteral reflux in 191 recipients who underwent ureteroneocystostomy during transplantation.
  
  
  
  The preoperative duration of dialysis therapy showed a significant negative correlation with bladder capacity (R2= 0.33, P < 0.001). The overall urological complication rate was 3.4% (14 patients), including urinary leakage (12 patients) and ureteral stricture (two patients). Univariate analysis showed that atrophic bladder, long-term dialysis therapy, deceased donor and ureteroureterostomy were associated with a higher incidence of urological complications (odds ratio 8.05, 4.43, 3.42 and 3.35; P < 0.01, P = 0.01, P = 0.04 and P = 0.04, respectively). Furthermore, multivariate analysis showed that atrophic bladder was the only significant factor associated with urological complications (odds ratio 10.37; P = 0.01). Among 191 recipients, vesicoureteral reflux was observed in 32 (16.8%). The incidence of vesicoureteral reflux was significantly higher in patients with atrophic bladder.
  
  
  
  Bladder atrophy in renal transplant recipients after long-term dialysis therapy is associated with a higher risk of urological complications.
authors.affiliation: Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Department of Renal Transplantation Surgery, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fukuzawa
authors.affiliation: Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Iwami
authors.affiliation: Department of Urology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Urology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Toshimori
authors.initials: T
authors.lastname: Seki
authors.affiliation: Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harada
mesh_terms: D000328:Adult; D001284:Atrophy / Q000453:epidemiology / Q000209:etiology; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D003559:Cystostomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology; D014519:Ureterostomy / Q000009:adverse effects / Q000379:methods; D001743:Urinary Bladder / Q000473:pathology*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000209:etiology
keywords: atrophic bladder; kidney transplantation; long-term dialysis; risk factor; urological complication