Increased urologic complications in children after kidney transplants for obstructive and reflux uropathy

Area of Science:

• Pediatric Nephrology
• Urology
• Transplantation

Background:

• Limited data exists on long-term outcomes for pediatric kidney transplant recipients with obstructive and reflux uropathy, especially during the cyclosporine era.
• Previous studies often lacked sufficient sample size, follow-up duration, or control groups.

Purpose of the Study:

• To evaluate long-term outcomes in a large cohort of pediatric kidney transplant recipients with obstructive and reflux uropathy.
• To compare patient survival, graft survival, urinary tract infections (UTIs), and urologic complications between patients with and without obstructive/reflux uropathy.

Main Methods:

• A single-center, matched-cohort study of 117 pediatric kidney transplant recipients (<20 years old) with obstructive and reflux uropathy and 117 controls.
• Kidney transplants were performed between April 1984 and October 2002.
• Outcomes assessed included patient and graft survival, UTIs, urologic complications, rejection, and estimated glomerular filtration rates.

Main Results:

• Patients with obstructive and reflux uropathy had significantly higher rates of urologic complications (43% vs. 11%) and UTIs (45% vs. 2%) compared to controls.
• No significant differences were observed in patient survival, graft survival, acute or chronic rejection, or mean estimated glomerular filtration rates.
• Higher rates of metabolic acidosis and UTIs were noted in study patients who underwent bladder augmentation.

Conclusions:

• Obstructive and reflux uropathy are associated with increased risks of urologic complications and UTIs in pediatric kidney transplant recipients.
• Despite these complications, long-term graft and patient survival are not compromised.
• Bladder augmentation in this cohort may be associated with increased metabolic acidosis and UTI rates.