Value of Routine Voiding Cystourethrography After Renal Transplantation

Abstract

The impact of vesicoureteral reflux (VUR) on renal allograft outcomes is debatable, with small cohort studies reporting controversial results. The objective of this retrospective study was to evaluate long-term clinical effects of early VUR in a large cohort of kidney transplant patients. Posttransplantation voiding cystourethrography was used to evaluate 646 consecutive kidney transplant recipients before discharge. The study endpoints included VUR grade, death-censored graft or patient survival, renal function, proteinuria and occurrence of urinary tract infections (UTIs). Of the 646 recipients, 263 (40.7%) were diagnosed with VUR. VUR grade II was most common (19.8%), followed by grades III (10.2%), I (7.9%) and IV (2.8%). VUR was less common in transplantations performed by experienced compared to inexperienced surgeons (36% vs. 48%; p = 0.004). VUR did not affect death-censored graft or patient survival and was not associated with proteinuria or occurrence of UTIs. Patients with VUR had a lower eGFR at 1 year after transplantation than did patients without VUR (60 vs. 52 mL/min/1.73 m 2 ; p = 0.02), although this difference was not observed at 3 and 5 years after transplantation. We conclude that early VUR, a common finding among renal transplant patients, may not have a meaningful impact on longterm transplant outcomes.

Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis

“…A study by Margreiter et al . has shown that vesicoureteral reflux has no effect on long‐term outcomes after kidney transplantation, although this study has several limitations . Owing to the difficulty to sufficiently detect vesicoureteral reflux and the disputable clinical implications, it was decided not to assess this outcome variable.…”

Acute Graft Pyelonephritis During the First Year After Renal Transplantation

“…In another study by Dupont et al, VUR was found in almost half of renal transplantation patients with recurrent UTIs, and patients with VUR were more prone to develop renal scarring than those without VUR [4]. On the other hand, in a recent study by Margreiter et al, 40% of 646 consecutive renal transplant recipients were diagnosed with VUR by voiding cystourethrography, and VUR did not affect the occurrence of UTIs [16]. Considering the significant influence of urinary flow abnormalities on the likelihood of AGPN development, we would strongly recommend systemic examination for VUR or urine flow obstruction at the first AGPN.…”

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

“…Therefore, early removal of ureteric stent is encouraged within 4 to 6 weeks post kidney transplant. Finally, renal transplant lithiasis is rather an uncommon event and the incidence is from 0.4% to 1% [33][34][35][36]. The modality for treating urinary tract calculi includes ESWL, Percutaneous nephrolithotomy (PCNL) and endoscopic laser lithotripsy.…”