Renal transplantation in children with severe lower urinary tract dysfunction

Area of Science:

• Pediatric Urology
• Nephrology
• Transplantation Surgery

Background:

• Congenital urological malformations often lead to end-stage renal disease (ESRD) in children.
• Renal transplantation outcomes in these children were historically poorer than in those with normal urinary tracts.
• Optimal urological management strategies for pediatric ESRD patients remain debated.

Purpose of the Study:

• To evaluate the outcomes of renal transplantation in children with ESRD caused by congenital lower urinary tract malformations.
• To assess the safety and efficacy of concurrent or staged urological reconstructions.
• To determine the impact of a multidisciplinary team approach on surgical success.

Main Methods:

• Retrospective review of 18 children (12 male, 6 female; mean age 8.4 years) undergoing renal transplantation between 1986 and 1998.
• Urological anomalies included posterior urethral valves, urogenital sinus anomalies, prune-belly syndrome, and others.
• Surgical interventions comprised bladder augmentation, continent urinary diversion, intestinal conduits, or transplantation into the native bladder.

Main Results:

• Patient survival was 100% and overall allograft survival was 81%.
• These survival rates were comparable to the general pediatric transplant population at the center.
• Technical complications occurred in 22% of patients, including ureteral obstruction and stomal issues.

Conclusions:

• Renal transplantation is a viable and successful treatment for children with ESRD and severe lower urinary tract dysfunction.
• Bladder reconstruction, whether performed before or after transplantation, is a safe and effective adjunct procedure.
• A multidisciplinary surgical team approach is recommended for optimal patient outcomes.