Trends in Renal Transplantation Rates in Patients with Congenital Urinary Tract Disorders

Area of Science:

• Pediatric Nephrology
• Urology
• Transplantation Medicine

Background:

• Congenital uropathy and congenital pediatric kidney disease necessitate renal replacement therapy, often including transplantation.
• Optimized bladder and renal management may delay the need for initial renal transplantation and improve outcomes.
• Understanding trends in transplantation timing and survival is crucial for managing these complex pediatric conditions.

Purpose of the Study:

• To determine if patients with congenital uropathy and congenital pediatric kidney disease experience a delayed time to first renal transplant.
• To evaluate if graft and patient survival rates differ between these two congenital kidney disease groups.
• To analyze trends in renal transplantation and survival from 1996 to 2012.

Main Methods:

• Analysis of the Scientific Registry of Transplant Recipients (SRTR) database.
• Inclusion of patients who received their first renal transplant between 1996 and 2012.
• Categorization of congenital conditions into uropathy (e.g., chronic pyelonephritis/reflux, prune belly syndrome) and pediatric kidney disease (e.g., polycystic kidney disease, dysplasia).

Main Results:

• A total of 7,088 patients with congenital uropathy and 24,315 with congenital pediatric kidney disease underwent first renal transplantation.
• Both groups showed a trend towards older age at initial transplantation, with notable decreases in younger age groups.
• While congenital uropathy initially showed better survival, age-matched comparisons revealed comparable 10-year graft and patient survival rates.

Conclusions:

• Patients with congenital lower and upper tract anomalies experienced a delayed time to first renal transplant over the study period.
• Age-matched graft and patient survival rates were similar regardless of whether the primary renal demise cause was congenital lower or upper tract.
• These findings suggest that advancements in urological and nephrological care contribute to renal preservation in these patient populations.