Bladder augmentation can be problematic with renal failure and transplantation

Alfrey, Edward J.; Salvatierra, Oscar; Tanney, Diana C.; Mak, Robert H.; Scandling, John D.; Dafoe, Donald C.; Hammer, Gregory B.; Orlandi, Pamela; Page, Leigh; Conley, Susan B.

doi:10.1007/s004670050362

Cited by 49 publications

(14 citation statements)

References 6 publications

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“…Earlier studies have suggested unacceptable UTI rates in children that require augmentation cystoplasty before kidney transplantation . Recently, Traxel demonstrated no increase in UTI rate following renal transplantation in these patients compared to a control group on CIC.…”

Section: Discussionmentioning

confidence: 94%

Kidney transplant in pediatric patients with severe bladder pathology

Sierralta

González

Nome

et al. 2015

Pediatric Transplantation

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The aim of the current study was to compare results in pediatric renal transplantation of patients with and without SBP. Between 2001 and 2013, a total of 168 kidney transplants were performed at our center. A retrospective analysis was performed and recipients were divided into two groups: NB and SBP. Incidence of surgical complications after procedure, and graft and patient survival were evaluated. A total of 155 recipients (92%) with complete data were analyzed, and 13 recipients that had had previous bladder surgeries were excluded (11 with VUR surgery and two with previous kidney transplants), of the 155 recipients: 123 (79%) patients had NB, and 32 (21%) patients had SBP, with a median follow-up of 60 (1-137) and 52 (1-144) months, respectively. Among post-transplant complications, UTI (68.8% vs. 23%, p < 0.0001) and symptomatic VUR to the graft (40.6% vs. 7.3%, p < 0.0001) were significantly higher in the SBP group. There was no significant difference in overall graft and patient survival between groups. Renal transplantation is safe in pediatric recipients with SBP; however, urologic complications such as UTI and VUR were significantly higher in this group. Graft and patient survival was similar in SBP and NB groups.

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Section: Discussionmentioning

confidence: 94%

Kidney transplant in pediatric patients with severe bladder pathology

Sierralta

González

Nome

et al. 2015

Pediatric Transplantation

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“…Uncorrected bladder function at the time of renal transplantation has been associated with reduced graft function and graft failure [3,4], although there is still controversy as to which operation should be done first. Those who advocate against augmenting first argue that there is an unacceptably greater risk of sepsis when the transplant is attached to an augmented ‘dry’ bladder, and that the augment pedicle is jeopardised at the time of transplantation [5–7]. However, most series tend to report good results for bladder augmentation before transplantation [8–17].…”

Section: Discussionmentioning

confidence: 99%

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

et al. 2007

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Paediatric urology can uncover the most complicated cases that require careful attention to management details. Authors from the UK present a retrospective review of their experience of children who had undergone both renal transplantation and bladder augmentation. They recommend that the bladder be reconstructed before renal transplantation, as it might protect the transplanted kidney, and specifically the transplanted ureter. OBJECTIVE To identify whether the order of performing transplant and bladder reconstruction operations in children who need both operations affects outcome of either operation. PATIENTS AND METHODS A retrospective case note review was performed of children identified from our database, who had undergone both renal transplantation and bladder augmentation between 1990 and 2005. RESULTS In all, 18 renal transplants (eight live‐related) were performed in 16 children with 10 transplants done after bladder augmentation and eight transplants done before augmentation. The median age at transplantation was 7.5 years and at augmentation was 7.0 years. The median interval between the operations was 33.5 months and the median follow‐up was 58.4 months after transplantation. Outcomes were compared between the two groups of patients: those who received their transplantation before bladder augmentation, and those who were transplanted after bladder augmentation. There was no difference between these groups in: the pre‐ transplant estimated glomerular filtration rate, inpatient stay after transplantation or after augmentation, and incidence of urinary tract infection in the 3 months after renal transplantation or after bladder augmentation. There was no statistical difference in renal allograft loss with one graft failure in the group who were augmented first, and four graft failures in the group who were transplanted first. However, it is of note that the single graft failure in the patient augmented first was due to renal artery thrombosis on the first day related to a double arterial anastomosis, whilst in the other group, three of the graft failures were in transplants that had initially been drained by ureterostomy. Three patients in the group transplanted first developed significant ureteric pathology, of which one developed graft failure. CONCLUSION Bladder reconstruction can be performed safely before transplantation; it does not increase complications and might better protect the renal graft and specifically the transplant ureter.

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“…Moreover, Alfrey et al. [16] reported severe UTI in children with transplantation into an augmented bladder, leading in one patient to graft loss, and to death of one other patient. In our patients antibiotic prophylaxis was not generally used, but administered to those with recurrent UTI.…”

Section: Discussionmentioning

confidence: 99%

Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation

et al. 2009

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OBJECTIVE To report a two‐stage protocol for children in whom bladder reconstruction was followed by kidney transplantation, as about a quarter of children requiring a kidney transplantation show significant lower urinary tract dysfunction, and consequently their bladder is unsuitable for a kidney transplant. PATIENTS AND METHODS Twelve children (median age 9.5 years, range 4.2–16.8) with end‐stage renal disease had a lower urinary tract reconstruction before kidney transplantation. The cause of bladder dysfunction and renal failure included posterior urethral valves in five, neuropathic bladder in two, prune‐belly syndrome in two, anal‐rectum and urethral atresia syndrome in one, primary obstructive uropathy in one and caudal regression syndrome in one. Two children were diverted with an ileal conduit; four had a bladder augmentation, and four had a bladder augmentation with additional continent cutaneous stoma. A continent urinary reservoir was constructed in one boy, and one boy had a Mitrofanoff‐only procedure. Subsequently, 11 children were transplanted. RESULTS The graft survival rate was 11 of 12 at 1 year and eight of 12 at 5 years. No patient lost the graft related to the reconstructed lower urinary tract. During the median (range) follow‐up of 5.4 (1.6–12.5) years all but one child had free drainage of the upper urinary tract. All 10 children who did not have an ileal conduit are continent. CONCLUSION Reconstruction of the lower urinary tract followed by renal transplantation is a safe and efficient approach. It has the advantage of restoring the lower urinary tract before immunosuppressive therapy, and supplies the best possible reservoir for a transplanted kidney.

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Bladder augmentation can be problematic with renal failure and transplantation

Cited by 49 publications

References 6 publications

Kidney transplant in pediatric patients with severe bladder pathology

Kidney transplant in pediatric patients with severe bladder pathology

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation

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