title: Renal Transplant in Patients With Abnormal Bladder: Impact of Causes on Graft Function and Survival.
abstract: OBJECTIVE
  Successful kidney transplant depends partly on the normal physiologic functioning of the bladder, which involves effective urine storage and emptying. The bladder may become abnormal owing to various urologic and neuropathic disorders. Patients with abnormal bladders need careful management before and after transplant. In this study, we aimed to determine the outcomes of renal transplants in relation to various causes of abnormal bladder.
  
  
  METHODS
  We conducted a retrospective review of 25 patients with abnormal bladder who received 30 renal transplants between 1990 and 2014. The patients were divided into neurologic and urologic groups based on the causes of abnormal bladder. Patient demographics, graft function, survival, and postoperative complications were compared.
  
  
  RESULTS
  The most common urologic cause was posterior urethral valve (14 patients), while the most common neurologic cause was spina bifida (6 patients). There was no statistically significant difference in graft survival at 1, 3, and 5 years between patients with neurologic and urologic causes of abnormal bladder as well as at long-term follow-up. However, the mean estimated glomerular filtration rate at 1, 3, and 5 years was higher among patients with neurologic causes than in those with urologic causes, although the difference was statistically significant only at 1 year (61 ± 34 vs 37 ± 19 mL/min; P = .025). Stone formation was reported only in patients whose abnormal bladder had neurologic causes, and no incidence was reported in patients with urologic causes (20% vs 0%; P = .038). The incidence of other postoperative complications was not statistically significant between the 2 groups.
  
  
  CONCLUSIONS
  With careful evaluation and proper preoperative correction of abnormal bladder dysfunction and optimization of the emptying and storage functions of the bladder, the causes of abnormal bladder did not appear to impact graft function and survival or overall rate of postoperative complications.
authors.affiliation: From the Urology Department, Menofia University Hospitals, Menofia, Egypt; and the Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Baher M
authors.initials: BM
authors.lastname: Salman
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Hassan
authors.forename: Sultan M
authors.initials: SM
authors.lastname: Sultan
authors.forename: Paul R
authors.initials: PR
authors.lastname: Tophill
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Halawa
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics; D055815:Young Adult