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Pediatric renal transplantation and the dysfunctional bladder.
1Department of Urology, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. judith.adams@med.uni-heidelberg.de
Summary
Pediatric renal transplantation into a dysfunctional lower urinary tract shows lower graft survival rates compared to other pediatric transplants. Urological complications significantly impact outcomes, necessitating pre-transplant correction of urinary tract abnormalities.
Area of Science:
- Pediatric Nephrology
- Urology
- Transplantation Immunology
Background:
- Lower urinary tract malformations are a significant cause of end-stage renal failure in children.
- Dysfunctional lower urinary tracts present unique challenges for successful renal transplantation.
Purpose of the Study:
- To evaluate graft survival, function, and urological complications in pediatric renal transplantation recipients with dysfunctional lower urinary tracts.
- To identify specific lower urinary tract abnormalities associated with differential graft survival rates.
Main Methods:
- Retrospective review of 349 pediatric renal transplantations performed between 1967 and March 2000.
- Analysis of graft survival rates based on underlying lower urinary tract malformations.
- Categorization of urinary tract disorders including neuropathic bladder, prune belly syndrome, VATER association, posterior urethral valves, and vesico-uretero-renal reflux.
Main Results:
- Overall 1-year graft survival was 83.3% for children with lower urinary tract malformations, compared to 88% for all pediatric transplant recipients.
- Graft survival varied significantly by underlying condition: 92.8% for vesico-ureteral reflux, 85.7% for VATER/prune belly syndrome, 75% for neurogenic bladder, and 74% for posterior urethral valves (1-year).
- Five-year graft survival was 70% for all children with lower urinary tract malformations, with posterior urethral valves showing the lowest rate (62.9%).
- Urological complications were noted to be high and potentially impact graft survival.
Conclusions:
- Pediatric renal transplantation into a dysfunctional lower urinary tract is associated with a higher risk of urological complications and potentially worse graft survival.
- Pre-transplant assessment and correction of all urological abnormalities are crucial for optimizing outcomes.
- Recipient classification based on urinary tract pathophysiology and anatomy is recommended for improved transplant planning.