Renal Transplantation in Recipients With Modified Lower Urinary Tract: A Systematic Review and Implications for Adult...

Adults with a modified lower urinary tract (MLUT) represent a growing but understudied population in renal transplantation. Concerns regarding long-term graft survival, infection, and urological morbidity persist, yet adult-specific outcome synthesis and clinically useful guidance are lacking.

We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of studies reporting posttransplant outcomes in adults with abnormal or surgically MLUT anatomy. Primary outcomes were 1- and 5-y graft and patient survival. Secondary outcomes included urological complications. Given substantial heterogeneity, data were synthesized narratively.

Twenty-four studies, including 511 MLUT recipients, were identified. Most were retrospective single-center series, and only a minority included comparator cohorts. Several studies included mixed adult-pediatric cohorts where adult-only outcomes could not be separated. Across comparative studies, 1-y graft survival appeared broadly similar between MLUT and control recipients, whereas 5-y graft survival was more often lower in MLUT cohorts. Patient survival was comparable, although long-term comparative data were limited. Urological morbidity was consistently greater in MLUT recipients, particularly recurrent urinary tract infection and the need for further urological intervention.

Renal transplantation in selected adults with MLUT is achievable with acceptable early outcomes, but the burden of urological morbidity is substantial, and longer-term graft outcomes are less favorable. These findings support careful pretransplant lower urinary tract assessment and highlight the need for pragmatic optimization pathways, although higher-quality prospective data remain necessary.