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The outcomes of kidney transplantation in children with urologic anomalies: a single center experience |
| Urology, Seoul National University Hospital, Pediatrics, Seoul National University Bundang Hospital, Pediatrics, Seoul National University Hospital, Pediatrics, Seoul National University Hospital, Urology, Seoul National University Hospital, Urology, Seoul National University Hospital |
| Min Hyuk Kim, Ji Hyun Kim, Hee Kyung Kang, Yo Han Ahn, Kwanjin Park, Youngjae Im |
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Background: Urologic anomalies make up a large proportion of the causes of ESRD. Meanwhile, complications and renal outcomes after kidney transplantation differs depending on the cause of ESRD. Some children with urologic anomalies have bladder dysfunction that can affect kidney function in the post-transplant period. / Objectives: Few studies have evaluated the differences and outcomes in children who underwent kidney transplantation for urologic vs nonurological etiology. We report the long-term outcomes of kidney transplantation in children with urologic problems. / Materials and Methods: We retrospectively reviewed 39 patients with ESRD caused by urologic anomalies among 233 patients who underwent kidney transplantation from 1985 to 2018 under 18 years of age. As a control group, 40 patients who underwent kidney transplantation with hereditary focal segmental glomerular sclerosis (FSGS) in the same period were selected. We analyzed postoperative outcomes in both groups. In addition, we also analyzed renal outcomes according to each detailed causative disease in the urologic anomalies group. / Results and Conclusion: ESRD by urologic anomalies in total pediatric kidney transplantation was 16.7%. There were 31 (79.5%) boys and 8 girls. The mean age at ESRD diagnosis was 12.1 years (0.4-33.2), mean age at kidney transplantation was 13.8 years (4.2-33.2). The mean follow-up period after kidney transplantation was 10.3 years (0.7-25.9). Among the Urologic anomalies, the reflux nephropathy by primary vesicoureteral reflux (VUR) was the highest in 28 patients (71.8%). The neurogenic bladder by spinal dysraphism (meningomyelocele, lipomeningomyelocele) was 5 (12.8%), and the valve bladder by posterior urethral valve (PUV) was 6 (15.4%). In a total of 7 neurogenic bladder patients with spinal dysraphism, 1 PUV and 1 primary VUR, augmentation cystoplasty was performed before kidney transplantation. As a result of confirming the urination status after kidney transplantation, 9 patients with augmentation cystoplasty performed CIC, and 30 showed self-voiding without any voiding symptoms. When comparing 39 patients with urologic anomalies and 40 with hereditary FSGS, the incidence of urinary tract infection (UTI) and rejection rate after kidney transplantation was significantly higher in urologic anomaly group, respectively (p=0.006, p=0.007). On the other hand, the rate of progression to CKD stage 3 or higher after kidney transplantation showed a significant difference between two groups (61.5% in the urologic anomalies group and 30% in the hereditary FSGS group, P=0.005). When we analyzed within urologic anomalies, the rejection rate was not significantly different with PUV 5 patients (83.3%), neurogenic bladder 3 (60%), and primary VUR 22 (78.6%) (p=0.630). However, graft failure was 0 in PUV 0, 3 (60%) in neurogenic bladder, and 3 (10.7%) in primary VUR, showing significant differences (p=0.008). In pediatric kidney transplantation, urologic etiology accounts for a significant proportion. And underlying urologic anomalies affects renal outcomes after kidney transplantation. We consider recurrent UTI is probably an important factor. Therefore, we should follow patients with kidney transplantation due to urologic anomalies closely. |
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keywords : urologic anomalies, pediatric kidney transplantation, postoperative outcomes |
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