Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up

Normal urinary bladder stores urine at low pressure, does not leak, and completely empties by natural voiding. An abnormal bladder may be due to neurologic or urologic disorders that render the bladder of small capacity, of high storage pressure, or of poor compliance. The aim of this study was to determine the long-term outcomes of renal transplant in patients with abnormal bladders.

We retrospectively compared 30 transplanted kidneys in 25 patients with abnormal bladders with a control group comprising 30 grafts transplanted simultaneously during the same period of time (1990-2014) in 30 patients without bladder abnormality. Patient demographics, graft function, survival, and postoperative complications were compared.

Patients with abnormal bladders received transplants at a younger age than the control group (32 ± 17 vs 47 ± 12 y; P <. 001). Graft survival was not significantly different between the study and the control groups at 1 (90% vs 97%; P = .30), 3 (88% vs 91%; P = .67), and 5 years (82% vs 87%; P = .68). On long-term follow-up (20 years), 19 grafts (63%) were functioning in the study group compared with 25 grafts (83%) in the control group, suggesting inferior survival in those with an abnormal bladder after the first 10 years of transplant. In the abnormal bladder group, there was higher incidence of urologic complications (93% vs 50%; P<.001).

Despite the earlier age at transplant, the previous urologic operations, and the high incidence of urinary tract infection after renal transplant, graft survival and functions after renal transplant were not significantly different between patients with abnormal and normal bladders over at least the first 10 years. Therefore, it is safe to transplant into abnormal bladders once they have been assessed, reconstructed if necessary, and managed appropriately.