Outcome of renal transplantation in patients with lower urinary tract abnormality

Patients with end stage renal failure (ESRF) and lower urinary tract abnormality (LUTA) are often considered high risk for renal transplantation. To examine the degree of risk, we have reviewed our experience of 44 patients who received a total of 58 renal allografts at the Western Infirmary, Glasgow, between 1978 and 1996. All patients had a detailed urological assessment and 19 of them underwent a urinary diversion procedure prior to transplantation. One-year patient and graft survival rates were 97% and 84%, respectively, while the five-year figures were 87% and 59%, respectively. The presence of an ileal conduit did not adversely affect graft survival (P = 0.52). The commonest complication was persistent urinary tract infection, which occurred in 15 (34%) patients. Of the 29 graft losses that occurred during the follow up period of 7-217 months, only one was due to infection of the transplant. We conclude that renal transplantation is a satisfactory option for patients with ESRF due to LUTA but that it is important to carry out detailed urological assessment prior to the transplant procedure.