Renal Transplantation in Children with Lower Urinary Tract Dysfunction: A Single-Center Experience
AbstractAim: To evaluate patient and graft survival, as well as the surgical risks of LUTD patients treated at Gazi University Transplantation Center. Renal transplantation in patients with lower urinary tract dysfunction (LUTD) of various origins remains challenging in the field of pediatric transplantation. Patients and Methods: Of 42 pediatric transplantation recipients treated since 2006, LUTD developed in five (12%). Videourodynamic tests were performed on all patients preoperatively, and postoperatively if required. The causes of urological disorders were: Posterior urethral valve (PUV) (n=3), PUV with a neurogenic bladder (n=1), and a meningiomyocele plus a neurogenic bladder (n=1). Continual intermittent catheterization (CIC) was required by three patients for bladder emptying. Three patients received kidneys from deceased donors and two patients received kidneys from living donors. All patients underwent calcineurine-based triple immunosuppressive therapy. No patient underwent pre-transplantation augmentation. Only one patient (with PUV and a neurogenic bladder) underwent an augmentation operation during transplantation surgery. We used the Haberal corner-saving suture technique for ureteral stenting combined with ureteroneocystostomic anastomosis. Results: The mean age at transplantation was 12.2±1.6 years (10-14 years). The median follow-up duration after transplantation was 101 months (68 to 110 months). Two of the five recipients developed BK virus nephropathy (BK). One of the grafts was lost to BK but the other retained normal functioning. No recipient developed urological or surgical complications after transplantation. Three grafts were lost [BK (n=1); chronic allograft nephropathy (n=2)] but the remaining two patients are doing well with median creatinine levels 1.1 mg/dL. The 1-, 3-, and 5-year patient and graft survival rates were: 100%, 100%, 100% and 100%, 100%, 60% respectively. Conclusion: Renal transplantation in children with a LUTD can yield long-term successful outcomes comparable to those in children with non-LUTD. Because of the high complication rates associated with these transplants, careful evaluation, surveillance, and management of pre/post-transplantation periods are essential to optimize these outcomes.
Shapiro R, Scantlebury VP, Jordan ML, Vivas C, Ellis D, Lombardozzi-Lane S, Gilboa N, Gritsch HA, Irish W, McCauley J, Fung JJ, Hakala TR, Simmons RL, Starzl TE. Pediatric renal transplantation under tacrolimus-based immunosuppression. Transplantation. 1999; 67: 299 -303
Benfield MR. Current status of kidney transplant: update 2003. Pediatr Clin North Am. 2003;50:1301-34
Luke PP, Herz DB, Bellinger MF, Chakrabarti P, Vivas CA, Scantlebury VP, Hakala TR, Jevnikar AM, Jain A, Shapiro R, Jordan ML. Long-term results of pediatric renal transplantation into a dysfunctional lower urinary tract. Transplantation. 2003;76:1578-82
Sözen H, Dalgic A, Karakayali H, Baskin E, Saatci U, Arslan G, Haberal M. Renal transplantation in children. Transplant Proc. 2006;38:426-9.
Haberal M, Emiroglu R, Karakayali H, Torgay A, Moray G, Arslan G, Sozen H, Dalgic A. A corner-saving ureteral reimplantation technique without stenting. Transplant Proc. 2006;38:548-5.
Haberal M, Dalgic A. New concepts in organ transplantation. Transplant Proc. 2004;36:1219-24.
Bohl DL, Brennan DC. Clin J Am. BK virus nephropathy and kidney transplantation. Soc Nephrol. 2007;2 Suppl 1:S36-46.
Salvatierra O. Pediatric renal transplantation. Transplant Proc. 1999;31:1787-8.
Bagchi S, Vikraman G, Srivastava SK, Upadhayay A, Singh G, Bhowmik D, Mahajan S, Dinda A, Agarwal SK. BK polyomavirus infection after renal transplantation: Surveillance in a resource-challenged setting. Transpl Infect Dis. 2017;19: Aug 21. doi: 10.1111/tid.12770
Pai D, Mann DM, Malik A, Hoover DR, Fyfe B, Mann RA. Risk factors for the development of BK virus nephropathy in renal transplant recipients Transplant Proc. 2015;47:2465-9.
Dharnidharka VR1, Cherikh WS, Abbott KC. An OPTN analysis of national registry data on treatment of BK virus allograft nephropathy in the United States. Transplantation. 2009;87:1019-26.
Ghirardo G, Midrio P, Zucchetta P, Gamba P, Zanon G, Murer L, Castagnetti M. Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome? Pediatr Nephrol. 2015;30:1337-42.
Saad IR, Habib E, ElSheemy MS, Abdel-Hakim M, Sheba M, Mosleh A, Salah DM, Bazaraa H, Fadel FI, Morsi HA, Badawy H. Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study. BJU Int. 2016;118:320-6.
Bilginer Y, Aki FT, Topaloglu R, Tekgul S, Demirkaya E, Düzova A, Besbas N, Ozen S, Erkan I, Bakkaloglu A, Bakkaloglu M. Renal transplantation in children with lower urinary tract dysfunction of different origin: a single-center experience. Transplant Proc. 2008;40:85-6.
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