Long-Term Renal Transplant Outcome in Patients With Posterior Urethral Valves. Prognostic Factors Related to Bladder Dysfunction Management
Open Access
- 11 May 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Pediatrics
Abstract
Introduction: To obtain a successful renal transplant (RT) outcome in patients with posterior urethral valves (PUV), it is necessary to accomplish an adequate bladder dysfunction treatment. Our aim was to determine prognostic factors related to bladder dysfunction management in long-term RT outcome in patients with PUV. Methods: A retrospective review of patients with PUV who received a first RT after 1985 in our institution with at least 5 years of follow-up was performed. Variables analyzed included prenatal diagnosis, age of diagnosis, initial presentation and management, bladder dysfunction treatment, other surgical treatments, pre-transplant dialysis, age of transplantation, type of donor, immunosuppression regimen, vascular and urological complications, rejections episodes, and graft survival. Results: Fifty-one patients were included in the analysis. Prenatal diagnosis was done in 37.3%. Median age of diagnosis was 0.30 (0–88) months. Initial presentation was vesicoureteral reflux (VUR) in 78% and obstructive ureterohydronefrosis in 35.3%. Initial management was valve ablation (29.4%), pyelo-ureterostomy (64.7%), and vesicostomy (5.9%). In 33.3%, a type of bladder dysfunction treatment was performed: 21.6% bladder augmentation (BA), 15.7% Mitrofanoff procedure, 17.6% anticholinergic drugs, and 27.5% clean intermittent catheterization (CIC). Pre-transplant dialysis was received by 66.7%. Transplantation was performed at 6.28 ± 5.12 years, 62.7% were cadaveric and 37.3% living-donor grafts. Acute rejection episodes were found in 23.6%. Urological complications included recurrent urinary tract infections (UTIs) (31.4%); native kidneys VUR (31.4%); graft VUR (45.1%); and ureteral obstruction (2%). Vascular complications occurred in 3.9%. Mean graft survival was 11.1 ± 6.9 years. Analyzing the prognostic factor that influenced graft survival, patients with had CIC or a Mitrofanoff procedure had a significant better long-term graft survival after 10 years of follow-up (p < 0.05), despite of the existence of more recurrent UTIs in them. A better graft survival was also found in living-donor transplants (p < 0.05). No significant differences were observed in long-term graft survival regarding native kidneys or graft VUR, BA, immunosuppression regimen, or post-transplant UTIs. Conclusion: Optimal bladder dysfunction treatment, including CIC with or without a Mitrofanoff procedure, might result in better long-term graft survival in patients with PUV. These procedures were not related to a worse RT outcome in spite of being associated with more frequent UTIs.This publication has 33 references indexed in Scilit:
- Long-term consequences of posterior urethral valvesJournal of Pediatric Urology, 2013
- Low Incidence of Urinary Tract Infections Following Renal Transplantation in Children With Bladder AugmentationJournal of Urology, 2011
- Posterior Urethral Valve Treatments and Outcomes in Children Receiving Kidney TransplantsJournal of Urology, 2011
- Impact of posterior urethral valves on pediatric renal transplantation: A single‐center comparative study of 297 casesPediatric Transplantation, 2011
- Kidney transplantation before or after augmentation cystoplasty in children with high‐pressure neurogenic bladderBJU International, 2008
- Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in childrenBJU International, 2007
- Pediatric renal transplantation and the dysfunctional bladderTransplant International, 2004
- Successful Renal Transplantation in Children With Posterior Urethral ValvesJournal of Urology, 2003
- Lower Urinary Tract Reconstruction is Safe and Effective in Children With End Stage Renal DiseaseJournal of Urology, 2003
- Limited surgical interventions in children with posterior urethral valves can lead to better outcomes following renal transplantationPediatric Transplantation, 2002