ESPN 51th Annual Meeting

ESPN 2018


 
PEDIATRIC RENAL TRANSPLANTATION IN PATIENTS WITH LOWER URINARY TRACT DYSFUNCTION
ECE MEKIK 1 ZEYNEP BIRSIN ÖZÇAKAR 1 NILGÜN ÇAKAR 1 EDA DIDEM KURT-ŞÜKÜR 1 FATOŞ YALÇINKAYA 1

1- ANKARA UNIVERSITY SCHOOL OF MEDICINE, PEDIATRIC NEPHROLOGY DEPARTMENT
 
Introduction:

 Lower urinary tract dysfunction(LUTD) is a challenging issue in renal transplantation(RTx) as it can be associated with increased risk of complications, urinary tract infection(UTI), allograft dysfunction and graft loss, compared to non-LUTD transplant recipients. The aim of this study is to determine the outcome of RTx in patients with LUTD.

Material and methods:

A single center retrospective study was performed. Across 70 patients who underwent RTx between 2007 and 2018, 10 patients with LUTD were included to the study.

Results:

 The mean age of the 10(8 male) patients was 16.4±4.7 years. The causes of LUTD were congenital vesicoureteral reflux(VUR) and posterior urethral valves(3 patients each), non-neurogenic neurogenic bladder(2), urofascial syndrome and Prune –Belly syndrome(1 patient each); anal atresia and hypospadias were accompanied in two and one patients, respectively. Patients were first diagnosed at 2.5±3.2 years. Clean intermittent catheterization(CIC)(4 patients) and anticholinergic treatment(8 patients) were used before RTx. Augmentation cystoplasty was performed during pre-transplant period in 4 patients and in one patient simultaneously with transplantation. Median age at RTx was 11.7(2.1-17.3) years and 4 patients received cadaveric organs. During post-RTx follow-up(median 63 (3-87) months), 9 patients needed CIC and 5 received anticholinergic treatment. Median creatinin level and glomerular filtration rate at the last visit were 0.9(0.4-5.2) mg/dL and 76.5(7-166) ml/min/1.73m2, respectively. The frequency of UTI was 6(0-13) per patient and 7 patients had the disease in the first 6 months after RTx. VUR was detected in 4 patients, all were surgically corrected. Amyloidosis developed in 1 patient because of continuing inflammation secondary to recurrent UTIs. Another patient lost her kidney due to treatment incompatibility.

Conclusions:

RTx is safe and effective in patients with end-stage kidney disease who concomitantly have LUTD. However, as LUTD carries high risk for complications in RTx, underlying urological problem should be managed properly during pre and post-transplant period. Patient compliance is also a major factor on outcome. A strategy aiming to minimize the risk of complications and prevent UTI’s, and maximize graft function and survival should be adopted.