Graft Survival in Patients With Lower Urinary Tract Dysfunction

Area of Science:

• Pediatric Nephrology
• Transplantation Immunology
• Urology

Background:

• Lower urinary tract dysfunction (LUTD) is a significant concern in pediatric renal transplant recipients.
• Understanding the impact of specific LUTD conditions like neurogenic bladder, posterior urethral valve (PUV), and vesicoureteral reflux nephropathy (VU R N) is crucial for optimizing outcomes.

Purpose of the Study:

• To determine the rates of urinary tract infection (UTI) and graft survival in pediatric renal transplant recipients with LUTD.
• To compare outcomes among patients with neurogenic bladder, PUV, and VU R N.

Main Methods:

• Retrospective analysis of 133 pediatric kidney transplant recipients.
• Patients categorized based on the presence and type of LUTD.
• Post-transplant UTI rates and estimated glomerular filtration rates (eGFR) were assessed.
• Graft survival rates were analyzed over 5 years.

Main Results:

• LUTD was present in 43.6% of patients.
• UTI rates were significantly higher in patients with LUTD compared to those without, particularly in the first year post-transplant.
• Neurogenic bladder patients exhibited the highest UTI rates and lowest eGFR.
• Five-year graft survival was similar for patients without LUTD and those with VU R N.

Conclusions:

• Neurogenic bladder is associated with poorer graft survival and increased UTI risk in pediatric kidney transplant recipients.
• While PUV and VU R N showed comparable graft survival to non-LUTD patients, careful monitoring for UTIs remains essential.
• Targeted management strategies for LUTD are vital for improving long-term graft function and survival.