MP79-20 THE IMPACT OF URETERAL COMPLICATIONS AFTER PEDIATRIC RENAL TRANSPLANTATION

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-20 THE IMPACT OF URETERAL COMPLICATIONS AFTER PEDIATRIC RENAL TRANSPLANTATION Julia B. Finkelstein, Jamie S. Pak, Jennifer J. Ahn, Jason P. Van Batavia, Mark V. Silva, Namrata G. Jain, and Shumyle Alam Julia B. FinkelsteinJulia B. Finkelstein More articles by this author , Jamie S. PakJamie S. Pak More articles by this author , Jennifer J. AhnJennifer J. Ahn More articles by this author , Jason P. Van BataviaJason P. Van Batavia More articles by this author , Mark V. SilvaMark V. Silva More articles by this author , Namrata G. JainNamrata G. Jain More articles by this author , and Shumyle AlamShumyle Alam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES After renal transplantation, the incidence of acute graft rejection has declined with advances in immunosuppressive regimens, making the evaluation of other risk factors for graft failure vital. Urologic issues and, in particular, ureteral complications (UC) are associated with increased patient and graft morbidity. We sought to investigate the incidence of UC and to assess their impact on post-transplant outcomes. METHODS We retrospectively reviewed 49 pediatric patients who underwent 57 renal transplants at a single institution from 2004 to 2014. 90% of patients had a Lich-Gregoire ureterocystostomy and 61% underwent ureteral stenting. We evaluated the incidence of UC, defined as vesicoureteral reflux (VUR), stricture, or obstruction, and compared the post-transplant outcomes of children with UC to those without known UC. Fisher's exact and Mann-Whitney U tests were performed for statistical analysis. RESULTS A screening post-transplant urodynamic study or VCUG was performed in 25 children. VUR was detected in 22 patients. The incidence of VUR in the other 24 recipients is not known. There were also 5 cases of strictures and 2 of obstruction. Overall, 29 UC were encountered in 24 patients (49%). There was no difference between groups in deceased versus living donor (p=0.91), warm ischemia time (p=0.51) or ureteral stenting (p=0.21). Children with UC were significantly more likely to be male (p=0.021), require a nephrostomy tube (p=0.050), develop UTIs (p<0.0001), and be hospitalized (p=0.0002). 95% of children with UC had creatinine values elevated from nadir (increase range 0.3-1.9 mg/dL). To date, 7 patients (29%) underwent 10 operations to treat UC. CONCLUSIONS Although only 25 children had urologic studies post-transplant, almost half of our renal transplant recipients had UC. These complications carried significant morbidity, with 58% of children having UTIs and 29% requiring surgery. The rise, sometimes markedly, in creatinine from nadir is concerning. Moreover, 88% of studies showed pathology, indicating the importance of post-transplant urologic evaluation. Interventions/Complications # Without Known UC (n=25) # With UC (n=24) p-value Nephrostomy Tube 0 4 (17%) 0.050 Urinary Tract Infections 0 14 (58%) <0.0001 Median Post-Transplant Admissions (IQR) 1 (0-3) 6 (3.5-11) 0.0002 Transplant Biopsy 10 (40%) 14 (67%) 0.088 Graft Rejection 7 (28%) 11 (46%) 0.244 Graft Failure 4 (16%) 3 (13%) 1.00 Creatinine Trend (change from nadir level) # of UC Patients (n=22) No change 1 (4.5%) Increased by: 50% 6 (27.3%) 100% 9 (41.0%) 200% 4 (18.2%) 400% 1 (4.5%) 700% 1 (4.5%) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1018 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia B. Finkelstein More articles by this author Jamie S. Pak More articles by this author Jennifer J. Ahn More articles by this author Jason P. Van Batavia More articles by this author Mark V. Silva More articles by this author Namrata G. Jain More articles by this author Shumyle Alam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...