Value of routine voiding cystourethrography after renal transplantation

Area of Science:

• Nephrology
• Transplantation Immunology
• Urology

Background:

• Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys.
• Its impact on kidney transplant outcomes remains controversial, with limited data from small studies.
• Early detection and management of VUR are crucial in post-transplant care.

Purpose of the Study:

• To investigate the long-term clinical effects of early vesicoureteral reflux (VUR) in a large cohort of kidney transplant recipients.
• To assess the association between VUR and graft survival, renal function, proteinuria, and urinary tract infections (UTIs).

Main Methods:

• Retrospective analysis of 646 kidney transplant recipients.
• Posttransplantation voiding cystourethrography performed before discharge to diagnose VUR.
• Evaluation of VUR grade, death-censored graft/patient survival, renal function (eGFR), proteinuria, and UTIs.

Main Results:

• Vesicoureteral reflux (VUR) was diagnosed in 40.7% of recipients, with grade II being most common.
• VUR was less frequent in transplants performed by experienced surgeons (36% vs. 48%).
• No significant impact of VUR on death-censored graft/patient survival, proteinuria, or UTIs.
• A transient decrease in eGFR at 1 year post-transplant in VUR patients, which normalized by 3-5 years.

Conclusions:

• Early vesicoureteral reflux (VUR) is a frequent finding in kidney transplant recipients.
• VUR does not appear to have a significant negative impact on long-term transplant outcomes.
• Monitoring renal function is important, especially in the first year post-transplant.