Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children?

Aki, Fazıl Tuncay; Aydın, Ahmet; Doğan, Hasan Serkan; Dönmez, Muhammet İrfan; Erkan, I.; Düzova, Ali; Topaloğlu, Rezan; Tekgül, Serdar

doi:10.1016/j.transproceed.2014.10.069

Cited by 24 publications

(24 citation statements)

References 13 publications

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“…Also, regarding recipient age at transplantation, onset, and duration of dialysis, none of the 12 studies described a significant difference in LUTD patients compared with NLUT. This is similar to our results 6‐15 …”

Section: Discussionsupporting

confidence: 93%

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Does renal transplant in children with LUTD improve their bladder function?

Aboulela

Fawzy

Abdelmawla

et al. 2020

Pediatric Transplantation

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Much is still unknown about LUT function after receiving renal graft. Graft function was the main focus of different studies discussing the same issue. However, these studies ignored the effects of the graft on lower tract function and more demand for bladder cycling and growth of the child. Therefore, we aimed at evaluating the LUT function after RT into patients with LUTD. We enrolled a retrospective cohort of 83 live renal transplant children with LUTD. The 44 patients in Group (A) had a defunctionalized bladder, and the 39 patients in Group (B) had underlying LUT pathology. All patients had clinical and urodynamic evaluation of LUT functions at least 1 year after RT. We found that the improvement in patients with impaired bladder compliance was 73% in Group (A) and 60% in Group (B), with no statistically significant difference between the study groups. In Group (B), there was statistically significant worsening of MFP (8.4%) and mean PVR (79.9%) after RT. In Group (A), mild but stable significant improvement of all clinical and urodynamic parameters was observed. Serum creatinine was significantly worse in patients with pathological LUTD compared with those with defunctionalized bladder but without significant effect on graft survival. All LUT variables seemed to have no adverse effect on graft survival except for use of CIC and augmented bladder. Incident UTI independent of LUT variables accounted for 20% of graft creatinine change.

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Section: Discussionsupporting

confidence: 93%

“…However, those studies did not report the changes that occurred in the LUT function under renal graft 4,5 . In addition, we compared our results to 10 other studies on the outcomes of pediatric RT in patients with LUTD alone or compared to a control group with NLUT 6‐15 …”

Section: Discussionmentioning

confidence: 97%

Does renal transplant in children with LUTD improve their bladder function?

Aboulela

Fawzy

Abdelmawla

et al. 2020

Pediatric Transplantation

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“…According to these authors, such infections should be resolved before transplantation. The increased risk of UTI in patients with neurogenic bladder, for instance, can be minimized with good patient selection, correct bladder emptying and maintaining low intravesical pressures (15). Our patients were evaluated in the pre-transplant period through radiological and urodynamic analysis and underwent cystoplasty (if required).…”

Section: Discussionmentioning

confidence: 99%

Symptomatic and asymptomatic bacteriuria in a pediatric cohort of kidney transplants from a hospital in Paraguay

et al. 2019

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Introduction: Bacteriuria is common in kidney transplant recipients (KTR) and it may affect graft survival. Objective: To describe the incidence, clinical manifestations and microbial susceptibility of the symptomatic (SB) and asymptomatic (AB) bacteriuria in KTR, and to define the initial empirical treatment. Methods: Retrospective cohort study of all KTR<18 years with bacteriuria that were transplanted between January 2006 and December 2016. Clinical, demographic, laboratory characteristics and follow-up time were investigated. Bacteriuria was classified as either SB or AB. Statistical analysis was performed using Excel 2010 program. Results: 20 kidney transplants were performed. The female/male ratio was approximately 2:1 and 45% of the patients had bacteriuria. Of the 55 bacteriuria episodes, 20 were symptomatic and 35 asymptomatic. The mean age of the patients was 10.7±4.7 years. The more frequent primary renal diseases were neurogenic bladder (44.4%), renal dysplasia (22.2%), nephronophthisis, vesicoureteral reflux and obstructive uropathy (11.1% each). The median number of episodes/patient was 3.9. The mean time to post-transplant presentation was <6 months in 25% of the cases, 6-12 months in 20% and >12 months in 54.5%. The median time between the transplantation and the first AB episode was 3 months, and between the first SB episode was 7 months. The symptoms found in patients with SB included fever (80%), hematuria (15%) and septic shock (5%). No patient died due to urinary tract infections (UTI), but 33.3% of the patients with bacteriuria required admission to intensive care units. The most frequent bacteria isolated was Escherichia coli (E.coli) (54.5%). Extended-spectrum beta-lactamase (ESBL) producing bacteria was found in 20% of the isolates. When comparing SB and AB, E.coli was associated with SB (p=0.047 OR:1-9.9). All SB cases were verified in patients with neurogenic bladder (p=0.013). Conclusion: The recognition of high incidence of ESBL producing bacteria-related to UTI in (children) KTR may be very important for decision on the use of antibiotics during post-transplantation period. In this case, the use of carbapenem and ciprofloxacin should be recommended as initial empiric treatment.

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“…The risk of urinary tract infection has been reported at 40%-60% by 3 years post-transplant in pediatric kidney transplant recipients with ESKD secondary to congenital anomalies of the kidney and urinary tract (31). Aki et al (32) showed that children with lower urinary tract dysfunction have a higher rate of urinary tract infection after kidney transplant. In the 2014 North American Pediatric Renal Trials Collaborative Studies Annual Report, rejection accounted for almost one half of the patients with graft failure (approximately 51%) (33).…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Children with Kidney Transplantation

Alkandari

Nguyen

Hébert

et al. 2018

CJASN

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Background and objectives AKI is associated with progression of CKD. Little is known about AKI after kidney transplantation in pediatric recipients. We aim to describe the epidemiology, risk factors, consequences, and outcomes of AKI in this population. Design, setting, participants, & measurements We performed a retrospective longitudinal analysis of pediatric kidney transplant recipients followed at The Hospital for Sick Children (Toronto, Canada) from 2001 to 2012. AKI was defined as an increase in serum creatinine $1.5 times baseline, and a rise of serum creatinine $1.25 but ,1.5 times baseline defined subacute AKI. Results Of 179 children, 122 were eligible for analysis. At baseline (3 months post-transplant), median age of the children was 13 years old (interquartile range, 9-16 years old), and 53% had CKD stage 2. Congenital anomalies of the kidney and urinary tract accounted for 46% of children. Over the study period (12 years), the incidence of AKI was 37% (n=45 children), and 65% (79 children) experienced subacute AKI. Twenty-seven percent (33 children) did not develop AKI or subacute AKI. The main causes of AKI were infections other than urinary tract infections, rejection, and urinary tract infections. In a multivariable Poisson regression analysis, independent risk factors for AKI included younger age, girls, grafts from deceased donors, and lower baseline eGFR. AKI was significantly associated with lower long-term GFR and graft loss independent of rejection episodes. Moreover, subacute AKI was associated with progression of CKD. Conclusions AKI and subacute AKI were common after pediatric kidney transplantation, and they were associated with graft loss, lower eGFR, and more rapid progression of CKD.

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Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children?

Cited by 24 publications

References 13 publications

Does renal transplant in children with LUTD improve their bladder function?

Does renal transplant in children with LUTD improve their bladder function?

Symptomatic and asymptomatic bacteriuria in a pediatric cohort of kidney transplants from a hospital in Paraguay

Acute Kidney Injury in Children with Kidney Transplantation

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