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Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children
Arash K Taghizadeh1, Divyesh Desai, Sarah E Ledermann
1Great Ormond Street Hospital For Children NHS Trust, London WC1N 3JH, UK. a.taghizadeh@ukonline.co.uk
Insights
Performing bladder reconstruction before a kidney transplant in children does not increase complications. This sequence may offer better protection for the renal graft and transplant ureter.
Area of Science:
- Pediatric surgery
- Urology
- Transplantation medicine
Background:
- Children requiring both renal transplantation and bladder reconstruction face complex surgical management.
- The optimal timing for these procedures is crucial for patient outcomes.
Purpose of the Study:
- To determine if the sequence of renal transplantation and bladder reconstruction impacts surgical outcomes in pediatric patients.
- To assess the safety and efficacy of performing bladder reconstruction before or after renal transplantation.
Main Methods:
- Retrospective review of pediatric patients who underwent both renal transplantation and bladder augmentation between 1990 and 2005.
- Comparison of outcomes between patients who received transplantation before augmentation versus those augmented first.
Main Results:
- No significant differences were observed in pre-transplant kidney function, hospital stay duration, or short-term urinary tract infection rates between the groups.
- Graft failure rates showed a trend towards better outcomes when bladder augmentation preceded transplantation, with fewer graft losses attributed to specific complications like ureteric pathology.
Conclusions:
- Bladder reconstruction can be safely performed prior to renal transplantation in children.
- Performing bladder reconstruction first may provide enhanced protection for the renal allograft and transplant ureter, without increasing overall complications.
Objective:
To identify whether the order of performing transplant and bladder reconstruction operations in children who need both operations affects outcome of either operation.
Patients And Methods:
A retrospective case note review was performed of children identified from our database, who had undergone both renal transplantation and bladder augmentation between 1990 and 2005.
Results:
In all, 18 renal transplants (eight live-related) were performed in 16 children with 10 transplants done after bladder augmentation and eight transplants done before augmentation. The median age at transplantation was 7.5 years and at augmentation was 7.0 years. The median interval between the operations was 33.5 months and the median follow-up was 58.4 months after transplantation. Outcomes were compared between the two groups of patients: those who received their transplantation before bladder augmentation, and those who were transplanted after bladder augmentation. There was no difference between these groups in: the pre- transplant estimated glomerular filtration rate, inpatient stay after transplantation or after augmentation, and incidence of urinary tract infection in the 3 months after renal transplantation or after bladder augmentation. There was no statistical difference in renal allograft loss with one graft failure in the group who were augmented first, and four graft failures in the group who were transplanted first. However, it is of note that the single graft failure in the patient augmented first was due to renal artery thrombosis on the first day related to a double arterial anastomosis, whilst in the other group, three of the graft failures were in transplants that had initially been drained by ureterostomy. Three patients in the group transplanted first developed significant ureteric pathology, of which one developed graft failure.
Conclusion:
Bladder reconstruction can be performed safely before transplantation; it does not increase complications and might better protect the renal graft and specifically the transplant ureter.
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