Augmentation cystoplasty before and after renal transplantation: long-term results

Basiri, Abbas; Moghaddam, S.M.M. Hosseini; Khoddam, R

doi:10.1016/s0041-1345(02)02869-5

Cited by 23 publications

(20 citation statements)

References 11 publications

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“…Similarly to reports by many other authors, we prefer reconstructive surgeries before RTx to avoid the possible adverse effects of immunosuppression, such as delayed wound healing and severe infection, in addition to the prevention of any harmful effect of LUTD on the graft [16,19]. It may not always be necessary to intervene in patients with borderline bladder compliance, however, as a small non-compliant bladder may improve after transplantation in some cases after restoration of urinary flow, sparing the patients a reconstructive surgery [10,21,22]. This requires close follow-up after transplantation to continuously assess the bladder and decide early on augmentation if needed.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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ObjectivesTo compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and MethodsA database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH 2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, MannWhitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. ResultsThe mean AE SD (range) age of the study cohort was 5.05 AE 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean AE SD follow-up was 4.52 AE 1.55 and 4.07 AE 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. ConclusionAcceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

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Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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“…The complication rate does not seem to increase among those who received a post-transplantation augmentation [8].…”

Section: Discussionmentioning

confidence: 81%

“…Ever since Marshall et al [9] performed their first KT in 1982 on a patient who had previously received BA, some 150 cases of pre-transplantation augmentation, and some 30 cases of augmentation after transplantation [5,7,8,10,11] have been reported in the literature. Papers describing performance of both procedures at the same time (BA + KT) are scarce.…”

Section: Discussionmentioning

confidence: 99%

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Kidney transplants in patients with bladder augmentation: correlation and evolution

et al. 2007

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“…Urinary tract infections (UTI) occur in at least a quarter of patients after renal transplantation, a rate that far exceeds that of the general population (2,3). The use of immunosuppression medications and ureteral stents along with ureteral reflux and altered bladder function may account for this increased risk (4,5,6,7). …”

Section: Introductionmentioning

confidence: 99%

Lower risk of urinary tract infection with low‐dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid‐withdrawal immunosuppression regimen

Giullian

Cavanaugh

Schaefer

2009

Clinical Transplantation

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Background Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/Sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low dose TMP/SMZ also reduces the risk of PCP, though its ability to reduce the risk of UTI is uncertain. Design Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression. Results Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early due to an adverse reaction. Urinary infection occurred in 16%, without a significant difference in the risk of UTI between those treated with dapsone versus those treated with TMP/SMZ (HR[95%CI]: 1.7 [0.75, 3.9], p=0.2). In the subset of patients who were older than age 47 years, (mean age for this cohort, SD +/−6.2 years) those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR[95%CI]: 4.3 [1.2, 15.5], p=0.024). Conclusions For renal transplant recipients over the age of 47 years, treated without long-term glucocorticoids, our retrospective data suggest low dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.

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Augmentation cystoplasty before and after renal transplantation: long-term results

Cited by 23 publications

References 11 publications

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Kidney transplants in patients with bladder augmentation: correlation and evolution

Lower risk of urinary tract infection with low‐dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid‐withdrawal immunosuppression regimen

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