Long-term adult renal graft outcome after ureteric drainage into an augmented bladder or ileal conduit

Abstract

Patients with an augmented or diverted urinary system are considered higher risk recipients in view of increased technical problems and infective complications. We studied the long-term renal graft function and survival in patients with a pretransplant ileal conduit or ileal/caecocystoplasty. Between 1986 and 1997, 14 of 1253 (1.1%) renal transplant recipients had their transplant ureters anastomosed into an abnormal urinary tract. These consisted of ten ileal conduits and four ileal/caecocystoplasties. Median follow up was 42 months (range 1-156). All ten ileal conduits were discharged with a functioning graft. There was one graft loss chronic rejection and one cardiac death. The median creatinine level was 130 mmol/l and 50% have a urinary infection. All the patients with an ileal/caecocystoplasty were discharged with a functioning graft and these are still functioning; median creatinine of 132 mmol/l and 75% have a urinary infection. One- and 3-year graft survival was 93% and 86%. We conclude that the long-term outcome of renal transplantation in carefully assessed patients with an abnormal urinary tract is satisfactory despite a high incidence of urinary infection.

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…In all of these studies, the small numbers of patients and the lack of suitable controls make it difficult to draw firm conclusions. This is understandable, since the number of patients who require pretransplant urinary diversion or bladder augmentation has generally been reported to be only 0.5-1.1% (866,875).…”

“…For patients in whom simple reimplantation into a dysfunctional bladder is not felt to be an option, surgical augmentation of the bladder prior to reimplantation may be possible (863)(864)(865)(866). Alternatively, using a preexisting urinary diversion obviates the need for additional surgery and may be an option for some (867,868).…”

“…Unfortunately, there are no randomized trials comparing different approaches to the pretransplant management of patients with defunctionalized bladders. In most small, observational studies, patients with pretransplant ileal conduits, augmented bladders, or continent reservoirs have had similar graft and patient survival rates compared to patients with normally functioning collecting systems (863)(864)(865)(866)(871)(872)(873)(874)(875)(876). Renal function has generally not been compromised (865,866,875,876).…”