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[Results of renal transplantation in children with obstructive uropathy due to malformations]
J P Squifflet1, U Caramuta, P Gianello
1Service de transplantation rénale et pancréatique, Université catholique de Louvain.
Insights
Pediatric renal transplants show better survival with living donors. Obstructive lower urinary tract uropathies in children increase post-transplant morbidity risks, despite similar graft survival rates.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Urology
Background:
- 180 pediatric renal transplants performed in children under 15 years old.
- Analysis of graft survival based on donor type (living vs. cadaver) and etiology of end-stage renal failure.
Purpose of the Study:
- To evaluate the outcomes of pediatric renal transplantation.
- To compare graft survival rates between living and cadaver donors.
- To assess the specific risks associated with obstructive lower urinary tract uropathies.
Main Methods:
- Retrospective analysis of 180 pediatric renal transplant cases.
- Comparison of graft actuarial survival rates at 5 years.
- Evaluation of morbidity in patients with chronic pyelonephritis versus obstructive uropathies.
Main Results:
- Graft survival is 20% better at 5 years for living donor kidneys compared to cadaveric.
- In patients with obstructive lower urinary tract uropathies (n=17), morbidity included 2 ureterovesical stenoses and 1 secondary vesico-ureteral reflux.
- Morbidity risk was higher in the obstructive uropathy subgroup (3/17) compared to other causes (4/163).
Conclusions:
- Living donor renal transplantation offers superior graft survival in pediatric patients.
- Obstructive lower urinary tract uropathies in children undergoing renal transplant are associated with increased post-operative morbidity.
- Careful monitoring for complications is crucial in pediatric renal transplant recipients with obstructive uropathies.
Abstract:
180 renal transplants have been performed at our center in children less than 15 years old. Even if the distribution is equivalent (50/50%) between kidneys from living and cadaver donors, graft actuarial survival rate is 20% better at 5 years in the first group. 42 grafts have been implanted for end-stage renal failure due to chronic pyelonephritis (CNP). Among them, 17 were due to obstructive L.U.T. uropathies (posterior urethral valves): even if the results are identical in that subgroup compared to CPN group, there is an increased morbidity risk as 2 ureterovesical stenosis and 1 secondary vesico-ureteral reflux were observed (3/17 versus 4/163 in the remnant population).