Transplantation rénale chez l’enfant porteur d’une anomalie du bas appareil urinaire

Abstract

Lower urinary tract dysfunction can lead to renal failure, owing to chronic infection and hypertension resulting from incomplete bladder drainage. These complications can recur after grafting. We compared the outcome of renal transplantation between patients with lower urinary tract dysfunction (group A) and upper urinary tract dysfunction (group B). One hundred twenty-seven kidney transplants were performed in 118 children in our institution between November 1988 and October 2005. Thirty-four patients had urinary tract anomalies (17 in group A, 17 in group B). The disorders in group A included posterior urethral valves (11 cases), neurogenic bladder (4 cases), bladder extrophy (1 case), and the Prune-Belly syndrome (1 case). We reviewed infectious and surgical complications, patient and graft survival, and graft function based on serum creatinine levels at 1, 5 and 10 years. Statistical analysis was based on the Mann-Whitney test. In group A, 5 patients had augmented bladder, 2 had incontinent urinary conduit, and 1 was transplanted on a pre-existing cutaneous ureterostomy. In nine cases, transplantation was performed on the native bladder, with no preparation. Seven complications were noted in group A, consisting of recurrent pyelonephritis (2 cases), renal abscess (1 case), upper urinary tract dilation (3 cases), lithiasis (1 case) and urinary tract incrustation by Corynebacterium in the ureterocutaneous conduit (1 case). Three complications occurred in group B, consisting of acute pyelonephritis (2 cases) and urinary tract infection with prostatitis and epididymitis (1 case). Complications tended to be more frequent in group A, but the difference was not significant (p=0.246). Mean graft survival is 5.29 years in group A and 5.97 years in group B (p=0.76). There was no difference between the two groups as regards the serum creatinine level at 1 year (p=0.77 ; Mann-Whitney test), 5 years (p=0.81) or at the end of follow-up (p=0.75). These results suggest that renal transplantation is similarly feasible in children with upper and lower urinary tract dysfunction. Indeed, we found no significant difference between the groups in terms of patient survival or graft survival and function.