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Vesicoureteral Reflux in Transplanted Kidney Among Children With Congenital Anomalies of Kidney and Urinary Tract:
Priscila Cardoso Braz Ascar1,2, Camila Correa Penedo1, Camila Penteado Genzani1
1Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, São Paulo, Brazil.
Insights
Pediatric kidney transplant patients with congenital anomalies of the kidney and urinary tract (CAKUT) and graft reflux showed similar graft survival rates compared to those without reflux. This finding impacts understanding of post-transplant outcomes in CAKUT patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Urology
Background:
- Congenital anomalies of the kidney and urinary tract (CAKUT) are a leading cause of pediatric kidney failure.
- Renal transplantation improves quality of life for children with kidney failure.
- The impact of graft reflux on graft survival in CAKUT patients post-transplantation is not well understood.
Purpose of the Study:
- To compare graft and patient survival in pediatric CAKUT patients with and without vesicoureteral reflux (VUR) in the transplanted kidney.
- To determine the influence of post-transplant reflux on graft function and survival.
Main Methods:
- Retrospective case-control study of 257 pediatric CAKUT patients undergoing first renal transplantation (April 2008 - October 2021).
- Patients were stratified into groups with and without post-transplant VUR based on voiding cystourethrogram.
- Six-year graft and patient survivals were analyzed using Kaplan-Meier curves and log-rank tests.
Main Results:
- Of 257 CAKUT patients, 63 underwent voiding cystourethrogram, with 48 (76%) showing reflux in the transplanted kidney.
- Estimated six-year graft survival was 72% in controls (no reflux) versus 96% in cases (with reflux).
- Median follow-up was 7.6 years for controls and 6.6 years for cases (p=0.383).
Conclusions:
- Pediatric CAKUT patients with reflux in the transplanted kidney demonstrated comparable graft and patient survival rates to those without reflux.
- Post-transplant VUR does not appear to negatively impact graft survival in this cohort.
Background:
Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of kidney failure in childhood. Renal transplantation is the modality of treatment used for kidney failure that promotes improved quality of life for pediatric patients. It is believed that patients with CAKUT are more predisposed to developing graft reflux in the post-transplant period, but its influence on graft survival is poorly understood. A comparative analysis between patients with and without VUR in the graft was made to determine the impact of reflux on graft function and survival in pediatric CAKUT patients.
Methods:
A retrospective case-control study of patients undergoing first renal transplantation between April 2008 and October 2021 was done. The study included CAKUT individuals who underwent voiding cystourethrogram after transplantation. Patients were stratified into a group without reflux in the transplanted kidney (controls) and a group with reflux (cases). Six-year graft and patient survivals were calculated and compared using Kaplan-Meier curves and the log-rank test.
Results:
A total of 257 CAKUT patients were studied. Of this group, 63 (24%) underwent voiding cystourethrogram after transplantation, and 48 (76%) had reflux in the transplanted kidney. Estimated six-year survival of the graft was 72% in the control group versus 96% in the case group (log-rank 0.889). The median follow-up time after transplantation in years was 7.6 in controls and 6.6 in cases (p = 0.383).
Conclusions:
Pediatric patients with CAKUT who presented reflux in transplanted kidneys had similar graft and patient survivals compared to patients without reflux.
