Urological complications in pediatric renal transplantation

In this study, we evaluated the urological complications and their consequences after renal transplantation in children.

A retrospective study was performed concerning urological complications after kidney transplantation in children at the University Medical Center St Radboud Nijmegen from August 1977 until July 1999. The mean age of the cadaver kidney donors was 23.2 (range 1-74.3) years.

In this period 146 children received 183 renal allografts. Twenty-four urological complications (13.1%) were noted in 23 patients. Urinary leakage was seen in 8 cases (4.4%) and a ureteral stenosis was present in 7 cases (3.8%), 5 patients developed stones (2.7%) and 4 severe lymph leakage needing surgical treatment (2.2%). In 3 patients the urological complication induced graft loss. In cadaver kidneys from donors younger than 5 years there was no significantly increased complication rate in comparison to older cadaver kidneys [2/32 (6.3%) versus 16/125 (12.2%)]. In a subgroup of 24 patients treated for severe posterior urethral valves the complication rate was not significantly increased in comparison to the others (8.3% in the group with posterior urethral valves against 13.7% in the group without).

Urological complications are a small threat for graft function and the results are comparable with earlier studies. Routine ultrasound can be important for early detection of problems in the postoperative period. A close observation in the postoperative care and good collaboration between pediatric nephrologist and urologist is mandatory. Sometimes, early intervention can be undertaken with the possibility of saving graft function and reducing morbidity.