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Transplanting patients with abnormal lower urinary tracts
P J Griffin1, T P Stephenson, S Brough
1Department of Transplantation, Royal Infirmary, Cardiff, UK.
Summary
Kidney transplant outcomes are favorable for patients with bladder dysfunction. Successful renal transplantation is achievable after addressing the underlying causes of renal failure from detrusor/sphincter issues.
Area of Science:
- Nephrology
- Urology
- Transplantation
Background:
- Bladder outlet obstruction and dysfunction can lead to end-stage renal disease.
- Kidney transplantation is a potential treatment for renal failure caused by lower urinary tract issues.
Purpose of the Study:
- To evaluate the outcomes of kidney transplantation in patients with bladder dysfunction.
- To compare graft and patient survival rates in transplanted patients with and without lower urinary tract abnormalities.
Main Methods:
- Retrospective analysis of 23 patients undergoing 28 kidney transplants for renal failure due to bladder dysfunction.
- Urodynamic assessment and bladder reconstruction were performed in most cases prior to transplantation.
- Comparison with a cohort of kidney transplant recipients with normal lower urinary tracts.
Main Results:
- Actuarial graft survival at 5 years was 70% for patients with bladder dysfunction and 70% for controls.
- Patient survival at 5 years was 82% for the bladder dysfunction group and 90% for the control group.
- Successful transplantation was achieved in most patients, with 25 out of 28 receiving their own bladder.
Conclusions:
- Kidney transplantation is a viable option for patients with renal failure secondary to bladder or bladder outlet dysfunction.
- Successful outcomes are dependent on identifying and correcting the underlying lower urinary tract abnormalities.
- Reconstruction of the native bladder is a feasible approach for these patients, yielding good survival rates.