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Updated: Jun 18, 2026
An Immature Murine Model of Reversible Unilateral Ureteral Obstruction
Published on: April 4, 2025
Risk factors and treatment success for ureteral obstruction after pediatric renal transplantation
Kenneth M Smith1, Andrew Windsperger, Shaheen Alanee
1Department of Urologic Surgery, Pediatric Division, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Pediatric kidney transplant recipients with posterior urethral valves face a higher risk of ureteral obstruction. This complication, while challenging, did not significantly impact graft loss or patient survival in this study.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Urology
Background:
- Ureteral obstruction is a known complication after pediatric renal transplantation.
- Risk factors and treatment efficacy for this complication remain poorly understood.
Purpose of the Study:
- To identify risk factors for ureteral obstruction following pediatric renal transplantation.
- To evaluate treatment efficacy for ureteral obstruction in this population.
Main Methods:
- Retrospective review of a single-center pediatric renal transplant database (1984-2008).
- Analysis of donor/recipient demographics, surgical techniques, complications, and graft outcomes.
- Statistical analysis including univariate and multivariate logistic regression and Kaplan-Meier survival analysis.
Main Results:
- Ureteral obstruction occurred in 8% of 526 pediatric renal transplants.
- Posterior urethral valves were the only significant risk factor for ureteral obstruction (OR 7.59, p <0.0001).
- Obstruction, stenting, or dilation did not significantly increase graft loss or patient death.
Conclusions:
- Posterior urethral valves are a significant risk factor for post-transplant ureteral obstruction in children.
- Clinical vigilance is crucial for managing this challenging complication.
- Potential contributing factors include ischemia and bladder wall changes associated with posterior urethral valves.
Purpose:
Risk factors and treatment efficacy for ureteral obstruction following pediatric renal transplantation are poorly understood. We describe a single center experience with pediatric transplant recipients in an effort to discern risk factors and treatment efficacy.
Materials And Methods:
We retrospectively reviewed the pediatric renal transplant database at our institution from January 1984 to March 2008. Donor and recipient demographics, treatment indications, graft characteristics, surgical techniques, treatment course, complications and graft outcomes were abstracted from clinical records.
Results:
A total of 449 children (mean age 8.6 years) who underwent 526 renal transplants were included in the study. Ureteral obstruction requiring intervention developed in 42 cases (8%). Recipient age and gender, recipient and donor race, donor harvest technique, ureterovesical anastomosis with or without stenting, number of donor arteries, number of human leukocyte antigen mismatches, prior renal transplant and ischemia time were not significantly associated with increased incidence of ureteral obstruction. Renal failure secondary to posterior urethral valves was the only parameter significantly associated with increased incidence of ureteral obstruction (univariate OR 4.93, p = <0.0001; multivariate point estimate 7.59, p <0.0001). Of patients with ureteral obstruction 48% presented within 100 days after transplant. Kaplan-Meier analysis showed significantly decreased ureteral obstruction-free survival in patients with vs without posterior urethral valves (log rank test, p <0.0001). Ureteral obstruction, stenting and dilation were not significantly associated with increased graft loss or patient death.
Conclusions:
Ureteral obstruction after renal transplantation in children is a challenging complication that demands clinical vigilance. Posterior urethral valves appear to be a significant risk factor for post-transplant ureteral obstruction likely due to local factors such as ischemia, thick bladder wall and collagen remodeling.
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