Renal Transplantation in Children with Lower Urinary Tract Dysfunction: A Single-Center Experience

Abstract

Aim: To evaluate patient and graft survival, as well as the surgical risks of LUTD patients treated at Gazi University Transplantation Center. Renal transplantation in patients with lower urinary tract dysfunction (LUTD) of various origins remains challenging in the field of pediatric transplantation. Patients and Methods: Of 42 pediatric transplantation recipients treated since 2006, LUTD developed in five (12%). Videourodynamic tests were performed on all patients preoperatively, and postoperatively if required. The causes of urological disorders were: Posterior urethral valve (PUV) (n=3), PUV with a neurogenic bladder (n=1), and a meningiomyocele plus a neurogenic bladder (n=1). Continual intermittent catheterization (CIC) was required by three patients for bladder emptying. Three patients received kidneys from deceased donors and two patients received kidneys from living donors. All patients underwent calcineurine-based triple immunosuppressive therapy. No patient underwent pre-transplantation augmentation. Only one patient (with PUV and a neurogenic bladder) underwent an augmentation operation during transplantation surgery. We used the Haberal corner-saving suture technique for ureteral stenting combined with ureteroneocystostomic anastomosis. Results: The mean age at transplantation was 12.2±1.6 years (10-14 years). The median follow-up duration after transplantation was 101 months (68 to 110 months). Two of the five recipients developed BK virus nephropathy (BK). One of the grafts was lost to BK but the other retained normal functioning. No recipient developed urological or surgical complications after transplantation. Three grafts were lost [BK (n=1); chronic allograft nephropathy (n=2)] but the remaining two patients are doing well with median creatinine levels 1.1 mg/dL. The 1-, 3-, and 5-year patient and graft survival rates were: 100%, 100%, 100% and 100%, 100%, 60% respectively. Conclusion: Renal transplantation in children with a LUTD can yield long-term successful outcomes comparable to those in children with non-LUTD. Because of the high complication rates associated with these transplants, careful evaluation, surveillance, and management of pre/post-transplantation periods are essential to optimize these outcomes.