Objective Adolescence is a time of significant change for patients, guardians, and clinicians. The Paediatrician must ensure patients develop the necessary skills and knowledge required to transition and to function as an independent entity, with autonomy over their own care. The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressant medicines and poor attendance at scheduled appointments. This systematic review was conducted to ascertain the transitional care models available to clinicians caring for kidney transplant recipients and to compare the approach in each respective case. Method A systematic review was performed, in a methodology outlined by the PRISMA guidelines. MEDLINE Ovid & EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric kidney transplant recipients between 1946 and Q3-2021. The reference lists of selected articles were also perused for further eligible studies and experts in the field for further eligible articles. Two investigators assessed all studies for eligibility and independently performed data extraction, any discrepancies were settled by consensus. Results A total of 1,121 abstracts were identified, which was reduced to 1,029 upon removal of duplicates. A total of 51 articles were deemed appropriate for full-text review and critical appraisal. Twelve articles which described models for transition pertaining to kidney transplant patients were included in qualitative synthesis. Every paper utilised a different transition model. All but one model included a physician and nurse at minimum in the transition process. The involvement of adult nephrologist medical social work, psychology and psychiatry was variable. The mean age for initiation of transition was 13.4 years range: 10-17.5 years. The mean age at transfer to adult services was 18.3 years range: 16-20.5 years. Conclusion Despite the well-established need for good transitional care in paediatric solid-organ transplant recipients, models tailored specifically for kidney transplant recipients are lacking. Further research and validation studies are required, to ascertain the most best method of providing effective transitional care to these patients. Transitional care should become a standardised process for adolescents and young adults with a kidney transplant.

Background: CAKUT are the most common cause of end-stage renal failure in children (Pediatr Nephrol. 24, 2009, 1719. Many children with CAKUT have poor urinary drainage which can compromise post-transplant outcome. Identifying safe ways to manage anatomical abnormalities and provide effective urinary drainage is key to transplant success. Much debate exists regarding optimum urinary diversion techniques. The definitive formation of a continent urinary diversion is always preferable but may not always be possible. We explore the role of ureterostomy formation at transplantation in a complex pediatric group. Methods:We report six pediatric patients who had ureterostomy formation at the time of transplantation at the National Paediatric Transplant Centre in Dublin, Ireland. We compared renal function and burden of urinary tract infection to a group with alternative urinary diversion procedures and a group with normal bladders over a 5-year period.Results: There was no demonstrable difference in estimated glomerular filtration rate between the groups at 5-year follow-up. The overall burden of UTI was low and similar in frequency between the three groups.Conclusions: Ureterostomy formation is a safe and effective option for temporary urinary diversion in children with complex abdominal anatomy facilitating transplantation; it is, however, important to consider the implications and risk of ureterostomy for definitive surgery after transplantation. K E Y W O R D S congenital anomalies of kidney and urinary tract, pediatric renal transplantation, ureterostomy, urinary diversion 1 | INTRODUC TI ON CAKUT include a variety of structural abnormalities which together account for the majority of end-stage renal disease, and a large proportion of renal transplantation in children. 1 Many children with CAKUT have significant bladder dysfunction, with poor drainage capability. 2,3 Historically children with CAKUT were often precluded from transplantation due to concerns regarding the impact of a dysfunctional How to cite this article: Costigan CS, Raftery T, Riordan M, et al. Long term outcome of transplant ureterostomy in children:

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