Renal transplantation in children with posterior urethral valves

Abstract

The objective of this study was to analyze whether renal transplantation (RT) in children with posterior urethral valves (PUV) constitutes a special group with respect to groups with different etiologies of end-stage renal disease (ESRD). Between 1979 and 2004, 22 RT were performed in 19 children with PUV. The median age at RT was 10 years (range: 1.3-17). Immunosuppression was provided by triple therapy and polyclonal/monoclonal antibodies. This group was compared with the two control groups: (1) glomerulopathy (n=62) and (2) pyelonephritis/dysplasia (n=42) without lower urinary tract disease, transplanted in the same period. Ten graft losses occurred in 22 transplants: thrombosis (2), acute rejection (3), chronic graft nephropathy (2), and death of patients (3) with a functioning graft in the 1st postoperative month. We did not find significant differences versus the control group in renal function or probability of graft or patient survival at 1, 5, and 10 years. We observed a greater risk of urological complication in patients with PUV. RT with PUV constitutes a special group due to the compulsory young age and the need for careful and complex medicosurgical management; nevertheless, the results achieved were similar to those obtained in our general RT population.

Increased Urologic Complications in Children After Kidney Transplants for Obstructive and Reflux Uropathy

“…Similar to previous studies, we found no significant difference in graft and patient survival rates between study patients and controls (3,5,6,8,9,16,21,32,33). Our 93% and 79% graft survival rates at 1 and 5 years posttransplant compare favorably with the 91% and 80% for LD KTx recipients as well as the 83% and 65% for deceased donor (DD) KTx recipients reported by the NAPRTCS (34).…”

“…In our study, the patients with obstructive and reflux uropathy had a higher incidence of urinary obstruction, urinary reflux, urolithiasis and UTIs, as compared with matched controls. Our 45% incidence of urologic complications is higher than the 19-35% reported in the literature (5,9,12,17,21,27,28). We suspect this difference is, in part, due to our longer follow-up period and our use of a detailed data base.…”

“…Urethral obstruction occurred in 17% of patients with prune-belly syndrome and in 5% of patients with PUVs. Mendizabal et al reported a 14% incidence of UVJ obstruction after 22 KTxs in 19 patients with PUVs, but their study did not include controls (21). Groenewegen et al reported a 10% incidence of UVJ in 20 KTx recipients with PUVs but the incidence did not differ in 25 controls (9).…”

“…According to recent data from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), 21.5% of pediatric kidney transplant (KTx) patients were identified as having lower urinary tract abnormalities (2). Decreased graft function was reported for children with ESRD due to obstructive and reflux uropathy who underwent a KTx in the pre-cyclosporine (CSA) era (3).…”

“…Decreased graft function was reported for children with ESRD due to obstructive and reflux uropathy who underwent a KTx in the pre-cyclosporine (CSA) era (3). Reports of children with obstructive uropathy who underwent a KTx in the CSA era have been limited by small numbers of study patients, short follow-up periods, or lack of control patients (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). We report long-term KTx outcomes in a large group of children with ESRD due to obstructive and reflux uropathy who received maintenance immunosuppression with CSA.…”