Renal Transplant in Children with Lower Urinary Tract Dysfunction: A Developing Country Experience

Abstract

Purpose Paediatric transplantation is challenging in many ways, especially so when it is performed in patients with history of lower urinary tract dysfunction. We report our experience of Paediatric renal transplants with and without lower urinary tract dysfunction. Material and Methods 300 Paediatric (2-18 years) living related renal transplants (LRRTX) were performed between 1986 and 2008. Among them twenty had (significant) lower urinary tract dysfunction, majority including posterior urethral valves and non neurogenic neuropathic bladders. Of the twenty, 16 had undergone augmentation cystoplasty using various bowel segments and mitrofanoff continent catheterizable channel and were trained for CISC prior to LRRTX. Pre transplant native kidney nephrectomies were performed in four patients for optimization. Results Average age of the patient was 14 years. One year and five year graft survival in both groups were similar, 92% and 80% respectively. Acute rejection episodes were 23%. Chronic rejection (63%) and infections were the main causes of graft losses. Recurrent urinary tract infection was the major complication encountered in patient with augmented bladders performing CISC. One patient needed redo ureteroneocystostomy. All graft ureters were reimplanted in native bladder. Post transplant, native kidney nephrectomy was needed in one patient because of pyonephrosis. Conclusions Renal transplantation provides equally good graft and patient survival even in patients with history of lower urinary tract abnormalities, at least in short term. However, frequent urinary tract infection carries a high risk for the graft.