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Ureteral Complications of Pediatric Renal Transplantation

Christopher D Morrison1, Rachel Shannon2, Ilina Rosoklija2

  • 1Department of Urology, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois.

The Journal of Urology
|September 10, 2018
PubMed

Insights

Pediatric renal transplant patients with bladder issues face higher ureteral complication risks, especially vesicoureteral reflux. A collaborative approach between urology and transplant surgery is recommended for these high-risk cases.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Transplantation Surgery

Background:

  • Ureteral complications are more frequent in pediatric renal transplant recipients than adults.
  • Identifying risk factors for ureteral complications is crucial for improving outcomes in this population.

Purpose of the Study:

  • To identify potential risk factors for ureteral complications in pediatric patients undergoing renal transplantation.
  • To analyze the association between patient and operative characteristics and postoperative ureteral complications.

Main Methods:

  • Retrospective cohort study of 224 renal transplantations in 219 pediatric patients (2004-2016).
  • Analysis of patient characteristics, operative factors, graft characteristics, and postoperative complications.
  • Comparison of ureteral complication rates based on the presence of underlying bladder pathology and surgical approach.

Main Results:

  • The overall rate of ureteral complications was 16%, with symptomatic vesicoureteral reflux being the most common.
  • Patients with preexisting bladder pathology had a significantly higher rate of ureteral complications (26% vs 12%, p = 0.01).
  • Urologists were more likely to perform ureteral anastomosis in patients requiring clean intermittent catheterization or with prior complex bladder reconstruction.

Conclusions:

  • Existing bladder pathology is a significant risk factor for ureteral complications, particularly vesicoureteral reflux, after pediatric renal transplantation.
  • A multidisciplinary approach involving urology and transplant surgery may benefit pediatric patients with bladder pathology undergoing renal transplantation.
Abstract

Keywords:
pediatricsreplantationtransplantationurinary bladder diseasesvesico-ureteral reflux

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