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Does renal transplant in children with LUTD improve their bladder function?

Waseem Aboulela1, Ahmed M Fawzy2, Mohamed A Abdelmawla3

  • 1Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt.

Pediatric Transplantation
|May 31, 2020
PubMed
Summary

Renal transplantation in children with lower urinary tract dysfunction (LUTD) shows varied outcomes. While bladder compliance improved, some experienced worsening function, though graft survival remained largely unaffected by LUT variables.

Keywords:
lower urinary tract dysfunctionpediatric kidney transplantrenal transplantationsurvivaltransplanted kidney/graft function

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Area of Science:

  • Urology
  • Pediatric Nephrology
  • Transplantation

Background:

  • Lower urinary tract (LUT) function post-renal transplant (RT) is understudied, with focus often limited to graft function.
  • Existing research overlooks the impact of RT on LUT function and its implications for pediatric patients' bladder cycling and growth.

Purpose of the Study:

  • To evaluate lower urinary tract (LUT) function in pediatric patients following renal transplantation (RT) for lower urinary tract dysfunction (LUTD).

Main Methods:

  • Retrospective cohort study of 83 pediatric renal transplant recipients with LUTD.
  • Patients were divided into two groups: defunctionalized bladder (Group A, n=44) and underlying LUT pathology (Group B, n=39).
  • Clinical and urodynamic evaluations of LUT function were performed at least one year post-RT.

Main Results:

  • Improved bladder compliance observed in both groups (73% in Group A, 60% in Group B), with no significant difference.
  • Group B showed significant worsening of maximal flow rate (MFP) and post-void residual (PVR) volume.
  • Group A demonstrated mild, stable improvements in clinical and urodynamic parameters.
  • Serum creatinine was worse in Group B, but graft survival was not significantly affected, except by clean intermittent catheterization (CIC) and augmented bladders.
  • Urinary tract infections (UTIs) independently contributed to graft creatinine changes.

Conclusions:

  • Renal transplantation can lead to improvements in bladder compliance in pediatric patients with LUTD, regardless of initial bladder status.
  • Patients with pre-existing LUT pathology may experience functional decline post-transplant.
  • LUT variables generally do not adversely affect graft survival, with exceptions noted for CIC and augmented bladders.