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Vesicoureteral reflux and urinary tract infections in renal transplant recipients
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Pediatric kidney transplant recipients had significantly less vesicoureteral reflux and fewer urinary tract infections with antireflux ureteroneocystostomy compared to nonantireflux techniques. Antireflux procedures are recommended for better allograft function.
Area of Science:
- Pediatric Urology
- Transplant Surgery
- Nephrology
Background:
- Vesicoureteral reflux (VUR) and urinary tract infections (UTIs) are common complications following pediatric kidney transplantation.
- The method of ureteral implantation can influence the incidence of postoperative VUR and subsequent infections.
Purpose of the Study:
- To compare the rates of postoperative VUR and UTIs between two ureteral implantation techniques in pediatric kidney transplant recipients.
- To determine the impact of VUR on infection rates and allograft function.
Main Methods:
- Retrospective evaluation of 56 children undergoing kidney transplantation.
- Comparison of nonantireflux extravesicular ureteroneocystostomy versus antireflux intravesicular ureteroneocystostomy.
- Assessment of VUR via diagnostic methods and monitoring of UTI frequency.
Main Results:
- Vesicoureteral reflux was significantly lower with the antireflux intravesicular technique (19%) compared to the nonantireflux extravesicular technique (79%).
- Urinary tract infection rates were substantially reduced following the antireflux procedure (1 per 40 patient-months) versus the nonantireflux procedure (1 per 11 patient-months).
- Children with VUR experienced a higher incidence of infection, irrespective of surgical technique.
Conclusions:
- Antireflux intravesicular ureteroneocystostomy is superior in preventing VUR and reducing UTIs after pediatric kidney transplantation.
- Preventing VUR is crucial for minimizing infection risk and preserving allograft function.
- An antireflux surgical approach is recommended for all pediatric kidney transplantations to optimize long-term outcomes.
Abstract:
Fifty-six children who received kidney transplants were evaluated for postoperative vesicoureteral reflux and frequency of urinary tract infection. Two methods of ureteral implantation were compared: a nonantireflux extravesicular ureteroneocystostomy and an antireflux intravesicular ureteroneocystostomy. Reflux was found in 79% of children who had the nonantireflux procedure vs 19% of children who had the antireflux procedure. This disparity was present regardless of sex and age. Infections occurred at a rate of one per 11 patient-months after the nonantireflux procedure vs one per 40 patient-months after the antireflux procedure. Regardless of surgical technique, the incidence of infection was higher in children with reflux. The potentially harmful effect of infection with reflux warrants concern. Because of the need to maximize allograft function for a longer time period, an antireflux procedure is recommended in all pediatric kidney transplants.