MP53-03 UROLOGIC RISK FACTORS FOR URINARY TRACT INFECTION AND ALLOGRAFT FAILURE IN PEDIATRIC RENAL TRANSPLANTATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP53-03 UROLOGIC RISK FACTORS FOR URINARY TRACT INFECTION AND ALLOGRAFT FAILURE IN PEDIATRIC RENAL TRANSPLANTATION Vinicius Seidel, Matthew Buell, Kai Wen Cheng, Cayde Ritchie, Adam Fisher, David Chamberlin, and Joshua Chamberlin Vinicius SeidelVinicius Seidel More articles by this author , Matthew BuellMatthew Buell More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Adam FisherAdam Fisher More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) causes morbidity in children with end stage renal disease (ESRD) and may lead to allograft failure. Appropriate urologic evaluation is important before and after renal transplantation. The purpose of this study is to identify risk factors for UTI and allograft failure in children with ESRD. METHODS: A retrospective review of all pediatric renal transplant patients at a single transplant center from 2013 to 2022 was performed. Inclusion criteria were patients less than 18 years of age with ESRD who underwent their first renal transplantation. Patients with less than 6 months follow-up were excluded. The primary endpoints were UTI occurrence and allograft failure. Allograft failure was defined as rejection with return to dialysis. Statistical comparisons were made using the Chi Square test and the Wilcoxon signed rank test. RESULTS: 79 children underwent renal transplantation with a median follow-up time of 56 months (6-112 months). Etiologies for renal failure were identified as renal in 60 (76%) patients and bladder in 19 (24%) patients. Renal failure in patients with congenital anomaly of kidney and urinary tract (CAKUT) was seen in 33% of renal etiologies and 100% of bladder etiologies. Overall, the UTI rate was lower pre-transplant (8%) compared to post-transplant (28%) (p=0.002). Pre-transplant bladder etiology for renal failure had a higher UTI rate when compared to the renal etiology (26% vs 2%, p=0.002). Post-transplant there was no difference in UTI rate between bladder etiology and renal etiology (37% vs 25%, p=0.32). 27% of patients had pre-transplant native kidney vesicoureteral reflux (VUR) and 11% had transplant kidney VUR. Children with native kidney VUR had a higher UTI rate pre-transplant (48% vs. 21%, p<0.05). Children with transplant kidney VUR had a higher UTI rate than those without transplant VUR (67% vs. 23%, p<0.05). Patients with poor bladder compliance and capacity on urodynamics when medically and surgically optimized, did not have increased post-transplant UTI rates. 14 (17.7%) patients developed allograft rejection. Etiology and onset time of initial renal failure, number of UTI, CAKUT, and VUR were not associated with allograft rejection. CONCLUSIONS: Pediatric ESRD patients with pre-transplant native kidney VUR and renal transplant VUR are at increased risk for UTI and should be treated. Unsafe bladders when optimized may safely undergo transplantation. Renal allograft failure was not associated with etiology, onset time of initial renal failure, number of UTI, CAKUT, and VUR. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e712 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinicius Seidel More articles by this author Matthew Buell More articles by this author Kai Wen Cheng More articles by this author Cayde Ritchie More articles by this author Adam Fisher More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...