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Clean Intermittent Catheterization in Children under 12 Years Does Not Have a Negative Impact on Long-Term Graft
Marios Marcou1,2, Matthias Galiano3,2, Anja Tzschoppe3,2
1Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany.
Insights
Clean intermittent catheterization (CIC) is safe for pediatric kidney transplant recipients, even with increased urinary tract infections. This therapy does not negatively impact long-term kidney graft survival in children.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Urology
Background:
- Congenital anomalies of the kidneys and urinary tract (CAKUTs) are a leading cause of pediatric end-stage renal disease (ESRD).
- Lower urinary tract dysfunction (LUTD) affects many children with CAKUTs, often necessitating clean intermittent catheterization (CIC).
- Concerns exist regarding the safety of CIC in immunosuppressed pediatric transplant patients due to potential febrile urinary tract infections (UTIs) and their impact on graft function.
Purpose of the Study:
- To evaluate the safety and impact of clean intermittent catheterization (CIC) on kidney graft survival in pediatric transplant recipients.
- To compare the incidence of febrile UTIs in children undergoing CIC versus those not requiring CIC.
Main Methods:
- Retrospective review of primary kidney transplant cases in children under twelve years old (2001-2020).
- Comparison of febrile UTI episodes and long-term kidney graft survival among three groups: CIC users, non-CIC urological ESRD patients, and non-urological ESRD patients.
- Statistical analysis to determine significant differences between groups.
Main Results:
- Eight of 41 pediatric kidney transplant recipients required CIC.
- Children undergoing CIC experienced significantly more febrile UTIs compared to non-urological ESRD controls (p=0.04), but not compared to urological ESRD non-CIC patients (p=0.19).
- Despite a higher UTI rate, CIC was not a risk factor for long-term kidney graft survival; survival rates were similar across all groups at median 124 months follow-up.
Conclusions:
- Clean intermittent catheterization (CIC) is a safe therapeutic option for pediatric kidney transplant recipients.
- Regular medical care ensures that CIC does not lead to increased long-term kidney graft loss.
- CIC can be safely employed in pediatric transplant patients with LUTD without compromising graft outcomes.
Background:
Congenital anomalies of the kidneys and urinary tract (CAKUTs) are one of the most prevalent primary causes of end-stage renal disease (ESRD) in young children, and approximately one-third of these children present with lower urinary tract dysfunction (LUTD). Many children with LUTD require therapy with clean intermittent catheterization (CIC). CIC commonly leads to bacteriuria, and considerations have arisen regarding whether CIC in immunosuppressed children is safe or whether repeated febrile urinary tract infections (UTIs) may lead to the deterioration of kidney graft function.
Material And Methods:
We retrospectively reviewed all cases of primary kidney transplantation performed in our center between 2001 and 2020 in recipients aged less than twelve years. The number of episodes of febrile UTIs as well as the long-term kidney graft survival of children undergoing CIC were compared to those of children with urological causes of ESRD not undergoing CIC, as well as to those of children with nonurological causes of ESRD.
Results:
Following successful kidney transplantation in 41 children, CIC was needed in 8 of these patients. These 8 children undergoing CIC had significantly more episodes of febrile UTIs than did the 18 children with a nonurological cause of ESRD (p = 0.04) but not the 15 children with a urological cause of ESRD who did not need to undergo CIC (p = 0.19). Despite being associated with a higher rate of febrile UTIs, CIC was not identified as a risk factor for long-term kidney graft survival, and long-term graft survival did not significantly differ between the three groups at a median follow-up of 124 months.
Conclusions:
Our study demonstrates that, under regular medical care, CIC following pediatric transplantation is safe and is not associated with a higher rate of long-term graft loss.
