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Vesicoureteral reflux after kidney transplantation in children
Insights
Vesicoureteral reflux (VUR) affects over half of pediatric kidney transplant recipients, increasing the risk of acute pyelonephritis (APN). Long-term antibiotic prophylaxis can prevent APN in these children.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Urology
Background:
- Vesicoureteral reflux (VUR) prevalence and impact post-kidney transplant are debated, with limited pediatric data.
- Understanding VUR in pediatric renal transplant recipients is crucial for optimizing outcomes.
Purpose of the Study:
- To investigate the incidence and consequences of VUR in a pediatric kidney transplant cohort.
- To assess the association between VUR and graft function, urinary tract infections, and pyelonephritis.
Main Methods:
- Retrospective analysis of 84 pediatric kidney transplant recipients over 5 years.
- Routine cystography performed on 55 children at a median of 8 months post-transplantation.
- Graft function and urinary tract infections monitored for 6 years.
Main Results:
- VUR into the graft was identified in 58% of pediatric kidney transplant recipients.
- Graft function and overall urinary tract infection rates were similar regardless of VUR status.
- Patients with VUR showed significantly worse outcomes regarding pyelonephritis development and recurrence.
Conclusions:
- Vesicoureteral reflux is common in pediatric renal transplant recipients, occurring in over half of cases.
- VUR is linked to an elevated risk of acute pyelonephritis (APN).
- Long-term antibiotic prophylaxis demonstrates potential in preventing recurrent APN in transplanted children with VUR.
Background:
The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation in adults varies between authors and there have been few reports in children.
Methods:
We conducted a retrospective study in a single-centre paediatric cohort. Fifty-five of the 84 children who underwent kidney transplantation over a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation.
Results:
VUR into the graft was present in 58% of the patients. Graft function and incidence of urinary-tract infections were similar in the two groups, independent of VUR. After having excluded infections attributed to the presence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with VUR (P:=0.017 and P:=0.0039 respectively). None of the eight patients with VUR treated with antibiotic prophylaxis after a first acute pyelonephritis (APN) episode presented subsequent APN after 4.4+/-3.3 years on therapy.
Conclusions:
VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.