RENAL TRANSPLANTATION IN CHILDREN WITH ABNORMAL LOWER URINARY TRACT: INTRODUCTION OF A NEW CONCEPT.

Abstract

P691 Aims: In this retrospective study, the outcome of renal transplantation in children with abnormal lower urinary tract (LUT) is reported. In addition, pre- and post-transplant urological treatments are stated. Methods: Between March 1981 and December 2001, 195 children (≤ 18 years of age) received live-donor kidney transplants. Out of these, 15 (14 males and 1 female, mean age 13.5 ± 3 years) had lower urinary tract disorders in the form of posterior urethral valve (PUV) with valve bladder (12) and neuropathic bladder secondary to meningomyelocele (3). These children were evaluated by voiding cystourethrogram, cystourethroscopy and cystometry. The children with PUV were run on clean intermittent catheterization (CIC) and a detrusor relaxant at least 3 months before transplantation. Augmentation ileocystoplasty and / or continent cutaneous diversion were used in 3 patients. The children were assessed for graft and patient survival and for complications compared to a group of children with normal LUT, who underwent renal transplantation during the same period. Results: One child died in the early posttransplant period due to rupture of external iliac artery. Followup ranged from 6 months to 16 years (mean = 4.5 years). Graft survival was comparable between the group of children with and without abnormal LUT, who underwent transplantation during the same period. Patient survival, mean serum creatinine and creatinine clearance were also comparable in both groups. The group with abnormal LUT showed a higher incidence of urinary fistula (3/14) and recurrent UTI and / or bacteremia (4/14). Otherwise both groups were comparable. Conclusions: Renal transplantation in children with abnormal LUT is feasible with good results. Pre-and post-transplant urologic management is critical for a successful outcome. A high incidence of urological and infectious complications should be anticipated and properly managed.