When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

Area of Science:

• Nephrology
• Pediatric Urology
• Transplant Surgery

Background:

• Antibiotic prophylaxis is no longer standard for preventing renal scarring in children with urinary tract infections (UTIs).
• Children with kidney transplants face an increased risk of UTIs.
• The management of vesicoureteral reflux (VUR) in renal transplant recipients requires careful consideration.

Purpose of the Study:

• To evaluate non-surgical management options for VUR in pediatric renal transplant recipients.
• To determine if select patients with VUR in renal grafts can avoid surgical intervention.
• To assess outcomes of VUR management in kidney transplant patients.

Main Methods:

• Retrospective review of 18 patients with VUR into renal grafts between 2006 and 2016.
• Analysis of VUR detection, treatment strategies, and graft function.
• Categorization of patients based on presenting symptoms (hydronephrosis, abnormal biopsy, recurrent febrile UTI).

Main Results:

• Of 18 patients with transplant VUR, 13 had grade 3 or 4 reflux.
• Nine patients without recurrent febrile UTI were successfully managed non-surgically (antibiotics, bladder training).
• Surgical intervention was required for most patients with recurrent febrile UTI; Dx/HA injection had a significant failure rate (78%).

Conclusions:

• Non-surgical management with bladder training and temporary antibiotic prophylaxis is effective for transplant VUR patients without febrile UTI.
• Patients with transplant VUR and recurrent febrile UTIs are more likely to need surgery.
• Dx/HA injection for VUR in transplant patients has a notable complication and failure rate, necessitating careful patient selection.