Predictors for abnormal voiding cystourethrography in pediatric patients undergoing renal transplant evaluation

Area of Science:

• Pediatric Nephrology
• Urology
• Transplantation Medicine

Background:

• The utility of pretransplant voiding cystourethrography (VCUG) in adults is debated due to low abnormal finding rates.
• Vesicoureteral reflux (VUR) is more prevalent in children, yet its relevance for pretransplant VCUG remains unevaluated in this population.

Purpose of the Study:

• To identify predictors of abnormal pretransplant VCUG findings in pediatric kidney transplant recipients.
• To assess the clinical relevance of abnormal pretransplant VCUG in children.

Main Methods:

• Retrospective cohort study of 271 pediatric renal transplants performed between 1980 and 1997.
• Logistic regression analysis to identify predictors of abnormal VCUG.
• Multi-variate analysis to determine the significance of identified predictors.

Main Results:

• Urologic etiology of end-stage renal disease (ESRD) was a strong predictor (OR 16.5, p < 0.0001) of abnormal VCUG.
• Age at transplantation under 8 years was also a significant predictor (OR 3.0, p = 0.0043).
• Abnormal pretransplant VCUG findings correlated with an over three-fold increased likelihood of requiring post-transplant urologic surgery.

Conclusions:

• Urologic causes of ESRD and younger age (<8 years) are independent predictors of abnormal pretransplant VCUG in children.
• Pretransplant VCUG findings are clinically relevant for decision-making regarding the test's necessity and for managing post-transplant urologic care.