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Patry C, Höcker B, Dello Strologo L, Baumann L, Grenda R, Peruzzi L, Oh J, Pape L, Weber LT, Weitz M, Awan A, Carraro A, Zirngibl M, Hansen M, Müller D, Bald M, Pecqueux C, Krupka K, Fichtner A, Tönshoff B, Nyarangi-Dix J. Timing of reconstruction of the lower urinary tract in pediatric kidney transplant recipients: A CERTAIN multicenter analysis of current practice. Pediatr Transplant 2022; 26:e14328. [PMID: 35689820 DOI: 10.1111/petr.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preexistent LUTD are considered a hostile environment, which might negatively impact KTx survival. In such cases, surgical reconstruction of the bladder is required. However, there is still disagreement on the optimal timing of the reconstruction procedure. METHODS This is a multicenter analysis of data from the CERTAIN Registry. Included were 62 children aged 8.18 ± 4.90 years, with LUTD. Study endpoints were the duration of initial posttransplant hospitalization, febrile UTIs, and a composite failure endpoint comprising decline of eGFR, graft loss, or death up to 5 years posttransplant. Outcome was compared to matched controls without bladder dysfunction. RESULTS Forty-one patients (66.1%) underwent pretransplant and 14 patients (22.6%) posttransplant reconstruction. Bladder augmentation was performed more frequently in the pretransplant (61%) than in the posttransplant group (21%, p = .013). Outcome in the pre- and posttransplant groups and in the subgroups of patients on pretransplant PD with major bladder surgery either pre- (n = 14) or posttransplant (n = 7) was comparable. Outcomes of the main study cohort and the matched control cohort (n = 119) were comparable during the first 4 years posttransplant; at year 5, there were more events of transplant dysfunction in the study cohort with LUTD than in controls (p = .03). CONCLUSIONS This multicenter analysis of the current practice of LUTD reconstruction in pediatric KTx recipients shows that pre- or posttransplant surgical reconstruction of the lower urinary tract is associated with a comparable 5-year outcome.
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Affiliation(s)
- Christian Patry
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Britta Höcker
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | | | - Lukas Baumann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Licia Peruzzi
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Children's Hospital, Turin, Italy
| | - Jun Oh
- Pediatric Nephrology, University Hospital Hamburg, Hamburg, Germany
| | - Lars Pape
- Clinic for Paediatrics III, Essen University Hospital, Essen, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital Cologne, Medical Faculty University of Cologne, Cologne, Germany
| | - Marcus Weitz
- Pediatric Nephrology Department, University Children's Hospital Zurich, Zurich, Switzerland.,Pediatric Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Atif Awan
- Department of National Paediatric Renal Transplantation, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Andrea Carraro
- Department of Pediatrics, University of Padova, Padova, Italy
| | - Matthias Zirngibl
- Pediatric Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Hansen
- KfH Kindernierenzentrum Frankfurt at Clementine Kinderhospital Frankfurt, Frankfurt, Germany
| | - Dominik Müller
- Departments of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité University Medicine, Berlin, Germany
| | - Martin Bald
- Pediatric Nephrology, Clinics of Stuttgart, Olgahospital, Stuttgart, Germany
| | - Carine Pecqueux
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Fichtner
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
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Aboulela W, Fawzy AM, Abdelmawla MA, Salah DM, Eldin MS, Mohamed Anwar AZ, El Ghoneimy M, Shouman AM, Shoukry AI, Bazaraa H, Tawfiek ER, Fadel F, Badawy H, Morsi HA, Ghoneima W. Does renal transplant in children with LUTD improve their bladder function? Pediatr Transplant 2020; 24:e13735. [PMID: 32472980 DOI: 10.1111/petr.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/01/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
Much is still unknown about LUT function after receiving renal graft. Graft function was the main focus of different studies discussing the same issue. However, these studies ignored the effects of the graft on lower tract function and more demand for bladder cycling and growth of the child. Therefore, we aimed at evaluating the LUT function after RT into patients with LUTD. We enrolled a retrospective cohort of 83 live renal transplant children with LUTD. The 44 patients in Group (A) had a defunctionalized bladder, and the 39 patients in Group (B) had underlying LUT pathology. All patients had clinical and urodynamic evaluation of LUT functions at least 1 year after RT. We found that the improvement in patients with impaired bladder compliance was 73% in Group (A) and 60% in Group (B), with no statistically significant difference between the study groups. In Group (B), there was statistically significant worsening of MFP (8.4%) and mean PVR (79.9%) after RT. In Group (A), mild but stable significant improvement of all clinical and urodynamic parameters was observed. Serum creatinine was significantly worse in patients with pathological LUTD compared with those with defunctionalized bladder but without significant effect on graft survival. All LUT variables seemed to have no adverse effect on graft survival except for use of CIC and augmented bladder. Incident UTI independent of LUT variables accounted for 20% of graft creatinine change.
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Affiliation(s)
- Waseem Aboulela
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Fawzy
- Urology Department, Minia Nephrology and Urology University Hospital, Minia University, Minia, Egypt
| | | | - Doaa M Salah
- Pediatric Renal Transplantation Unit, Pediatric Nephrology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohamed Salah Eldin
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed Zaki Mohamed Anwar
- Urology Department, Minia Nephrology and Urology University Hospital, Minia University, Minia, Egypt
| | - Mohamed El Ghoneimy
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Pediatric Renal Transplantation Unit, Pediatric Nephrology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Ehab R Tawfiek
- Urology Department, Minia Nephrology and Urology University Hospital, Minia University, Minia, Egypt
| | - Fatina Fadel
- Pediatric Renal Transplantation Unit, Pediatric Nephrology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - H Badawy
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Hani A Morsi
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
| | - Waleed Ghoneima
- Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt
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3
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Pediatric Kidney Transplantation in Patients With Urologic Anomalies. Transplant Proc 2019; 51:2257-2261. [DOI: 10.1016/j.transproceed.2019.01.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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4
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Kaya Aksoy G, Koyun M, Dinckan A, Aliosmanoglu I, Gemici A, Gultekin E, Comak E, Akman S. Graft Survival in Patients With Lower Urinary Tract Dysfunction. EXP CLIN TRANSPLANT 2019; 19:125-130. [PMID: 30702047 DOI: 10.6002/ect.2018.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We aimed to the determine urinary tract infection and graft survival rates in pediatric renal transplant recipients with lower urinary tract dysfunction with particular focus on neurogenic bladder, posterior urethral valve, and vesicoureteral reflux nephropathy. MATERIALS AND METHODS Patients were grouped according to primary diseases as those with and without lower urinary tract dysfunction. Urinary tract infections during year 1 posttransplant were investigated. Estimated glomerular filtration rate was calculated using Schwartz formula. RESULTS Our study investigated 133 kidney transplant recipients. Lower urinary tract dysfunction was found in 58 patients (43.6%): 25 with posterior urethral valve, 24 with vesicoureteral reflux nephropathy, and 9 with neurogenic bladder. Rates of posttransplant urinary tract infection were higher in patients with lower urinary tract dysfunction than in those without during both the first 6 months posttransplant (24.6% vs 10.8%; P = .037) and between posttransplant months 6 and 12 (24.6% vs 8.2%; P = .01). Patients with neurogenic bladder had the highest rate of urinary tract infections, and their estimated glomerular filtrations rates were lower compared with patients with posterior urethral valve and vesicoureteral reflux nephropathy at month 6 and years 1, 2, and 5 posttransplant (P < .001). The 5-year graft survival rates of patients without lower urinary tract dysfunction and those with vesicoureteral reflux nephropathy were similar (51.3% vs 51.6%; P = .891). CONCLUSIONS Graft survival rates of patients with posterior urethral valve and vesicoureteral reflux nephropathy were similar to those shown in patients without lower urinary system dysfunction; however, patients with neurogenic bladder had worse graft survival and urinary tract infection rates.
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Affiliation(s)
- Gulsah Kaya Aksoy
- From the Department of Pediatric Nephrology, Akdeniz University, School of Medicine, Antalya, Turkey
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Wilson RS, Courtney AE, Ko DSC, Maxwell AP, McDaid J. Long-Term Outcomes of Renal Transplant in Recipients With Lower Urinary Tract Dysfunction. EXP CLIN TRANSPLANT 2019; 17:11-17. [DOI: 10.6002/ect.2017.0137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Urologic causes of end-stage renal disease are estimated between 25% and 40% of causes. The goal of renal transplantation in chronic kidney disease patients is to provide renal replacement therapy with less morbidity, better quality of life, and improved overall survival compared with dialysis. A patient's urologic history can be a significant source of problems related to infections, recurrence of disease, and surgical complications. Many of the urologic risks are modifiable. Proper evaluation and management can mitigate the potential problems after transplantation, and these patients with complex urologic problems are seen to have similar graft function outcomes.
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Hussein AA, Shoukry AI, Fadel F, Morsi HAR, Hussein HA, Sheba M, El-Khateeb N, Abou-El Ela W, El-Sheemy M, Daw K, Shouman A, Lotfy A, Badawy H, Eissa M. Outcome of pediatric renal transplantation in urological versus non-urological causes of end stage renal disease: Does it matter? J Pediatr Urol 2018; 14:166.e1-166.e7. [PMID: 29223859 DOI: 10.1016/j.jpurol.2017.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Causes for end stage renal disease (ESRD) in children can be categorized into urological causes or non-urological causes. We sought to compare the outcomes of urological and non-urological causes of ESRD in children. METHODS Patients were divided into two groups: urological causes of ESRD versus non-urological causes of ESRD. All patients and donors had at least 6 months of follow-up. The main outcomes included the effect on complications and renal function. Comparisons were carried out using the chi-square test or the Student t-test. Multivariate logistic regression analysis was used to define the effect of different variables on the outcome of renal transplantation (Table). RESULTS Our study included 123 patients, 91 males. The mean age was 9 years and mean follow up was 46 months. Two-thirds of the patients had non-urological causes of ESRD. Overall survival was 100%, and only one patient needed a graft nephrectomy 3 months after the transplant. The mean estimated glomerular filtration rate was 117 mL/min, and did not differ significantly between the two groups (p = 0.13). Multivariable regression showed that female gender (OR 8.7, 95% CI 2.9-26, p = 0 0.0001) was associated with better renal function, while having a urological cause of ESRD (OR 0.28, CI 0.08-0.98, p = 0 0.05) was associated with worse renal function. Non-urological causes of ESRD were significantly less likely to develop complications following renal transplantation (OR 0.28, CI 0.09-0.89, p = 0 0.03). CONCLUSION Female patients with non-urological causes of ESRD are more likely to have better long-term renal functions, and less liable to develop complications following renal transplant.
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Affiliation(s)
| | | | - Fatina Fadel
- Department of Pediatric Nephrology, Cairo University, Egypt
| | | | | | | | | | | | | | - Kareem Daw
- Department of Urology, Cairo University, Egypt
| | | | - Amr Lotfy
- Department of Urology, Cairo University, Egypt
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8
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Melek E, Baskin E, Gulleroglu K, Bayrakci US, Moray G, Haberal M. Favorable Outcomes of Renal Transplant in Children With Abnormal Lower Urinary Tract. EXP CLIN TRANSPLANT 2016. [PMID: 27136101 DOI: 10.6002/ect.2016.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Chronic kidney disease caused by lower urinary tract abnormalities is a significant complication in pediatric care. Although there are conflicting reports about clinical outcomes in the past, favorable outcomes have been reported in recent years. Despite this, many centers still refrain from performing renal transplant in these patients. Here, we compared clinical outcomes of renal transplant recipients with and without lower urinary tract abnormalities. MATERIALS AND METHODS Our study included 71 renal transplant recipients who were divided into 3 groups: 17 patients with abnormal lower urinary tracts having vesicoureteral reflux (group 1), 7 patients with abnormal lower urinary tracts having bladder dysfunction (group 2), and 47 patients with anatomically and functionally normal lower urinary tracts (group 3). We retrospectively compared demographic features, clinical course, graft survival, pre- and posttransplant incidence of urinary tract infections, and final graft function among the groups. RESULTS There were no statistically significant differences among groups regarding median age at time of transplant, graft survival, median creatinine level, and median glomerular filtration rate (P > .05). Significant differences were shown in incidence of urinary tract infections between patients in groups 1 and 2 (abnormal lower urinary tracts) and group 3 (normal lower urinary tracts) before transplant (P < .05). Although frequency of urinary tract infections in groups 1 and 2 were moderately higher than shown in group 3 after transplant, this difference was not statistically significant. CONCLUSIONS Although the children with abnormal lower urinary tracts had slightly higher incidence of urinary tract infections, there were no differences between patients with abnormal and normal lower urinary tracts regarding allograft survival and function. In addition, proper follow-up of patients before and after transplant, based on our experience, should include educating patients and their parents about potential complications after transplant for the best outcome of renal transplant.
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Affiliation(s)
- Engin Melek
- From the Department of Pediatric Nephrology, Baskent University School of Medicine, Ankara, Turkey
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Saad IR, Habib E, ElSheemy MS, Abdel-Hakim M, Sheba M, Mosleh A, Salah DM, Bazaraa H, Fadel FI, Morsi HA, Badawy H. Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study. BJU Int 2015; 118:320-6. [PMID: 26434410 DOI: 10.1111/bju.13347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. PATIENTS AND METHODS A database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, Mann-Whitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. RESULTS The mean ± sd (range) age of the study cohort was 5.05 ± 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean ± sd follow-up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. CONCLUSION Acceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.
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Affiliation(s)
- Ismail R Saad
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammed S ElSheemy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mahmoud Abdel-Hakim
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mostafa Sheba
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Aziz Mosleh
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
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10
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Putz J, Leike S, Wirth MP. [Management of urological complications after renal transplantation]. Urologe A 2015; 54:1385-92. [PMID: 26459581 DOI: 10.1007/s00120-015-3908-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Urological complications after kidney transplantation can cause a major reduction in renal function. Surgical complications like urinary leakage and ureteral obstruction need to be solved by a specialist in the field of endourological procedures and open surgical interventions. The article summarizes this and other common urological problems after kidney transplantation.
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Affiliation(s)
- J Putz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S Leike
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - M P Wirth
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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11
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Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children? Transplant Proc 2015; 47:1114-6. [DOI: 10.1016/j.transproceed.2014.10.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/28/2014] [Indexed: 11/23/2022]
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12
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Teng L, Wang C, Li J. Long-term outcome of simultaneous or staged urinary diversion and kidney transplantation. Urol Int 2013; 91:310-4. [PMID: 24009016 DOI: 10.1159/000351322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/13/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We retrospectively analyzed the long-term outcomes of simultaneous or staged urinary diversion and kidney transplantation. PATIENTS AND METHODS Between June 2001 and December 2012, 4 patients with dysfunctional bladder resulting from spina bifida (n = 3) or bladder contraction following urologic tuberculosis (n = 1) underwent cadaveric kidney transplantation and urinary diversion simultaneously (n = 3) or 6 months post-transplantation (n = 1). Urinary diversion consisted of cutaneous ureterostomy in 1 patient and ileal conduits in 3 patients. All patients were followed prospectively. RESULTS All 4 patients received deceased donor transplants. Median follow-up was 110.5 months (range 50-120). At the last follow-up, serum creatinine levels ranged from 1.1 to 1.8 mg/dl. One patient with a functioning graft died of severe cirrhosis 105 months following transplantation. Graft function remained stable without any severe complications in 3 patients. Hematoma (Clavien-Dindo grade IIIa) and urinary leakage (grade II) occurred in 1 patient in the early postoperative period, but no surgical revision was required. Two patients developed cytomegalovirus pneumonia. Urinary tract infection was a common problem in all patients. CONCLUSIONS For patients with lower urinary tract dysfunction, simultaneous kidney transplantation and urinary diversion with an ileal conduit may be a safe, feasible approach, with a satisfactory long-term outcome.
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Affiliation(s)
- Lichen Teng
- Department of Urology, Third Affiliated Hospital, Harbin Medical University, Harbin, China
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13
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Silva A, Rodig N, Passerotti CP, Recabal P, Borer JG, Retik AB, Nguyen HT. Risk Factors for Urinary Tract Infection After Renal Transplantation and its Impact on Graft Function in Children and Young Adults. J Urol 2010; 184:1462-7. [DOI: 10.1016/j.juro.2010.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Andres Silva
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Nancy Rodig
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Carlo P. Passerotti
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Pedro Recabal
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Joseph G. Borer
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Alan B. Retik
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
| | - Hiep T. Nguyen
- Department of Urology and Department of Medicine, Division of Nephrology (NR), Children's Hospital, Boston, Massachusetts
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14
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Wang J, Xing N, Zhang X, Yan Y, Zhang J, Li X, Zhang W, Guan D. Orthotopic ileal neobladder reconstruction in patients with recurring bladder cancer after renal transplantation--a report of two cases and a review of the literature. Clin Transplant 2009; 23:700-4. [PMID: 19486344 DOI: 10.1111/j.1399-0012.2009.00988.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Renal transplant recipients have a high risk of developing multiple and invasive urothelial tumors because of long-term immunosuppression and infections with oncogenic viruses in China. However, treatment of renal transplant recipients who developed invasive bladder tumor is challenging. We aimed to evaluate the efficacy and safety of orthotopic ileal neobladder reconstruction following radical cystectomy in renal transplant recipients. Orthotopic ileal neobladder reconstruction and preservation of the transplanted kidney were performed in two patients after one and 36 months of transplantation, respectively. One recipient was lacking a bladder because of prior cystectomy before the transplantation, and the other developed multiple and invasive bladder cancer after the transplantation. During the 14-month and seven-yr follow-up postoperation, no serious complications occurred except slight hydronephrosis in one patient. No rejection and graft dysfunction occurred in both patients with reduced dosage of immunosuppressants, and serum creatinine as a marker of renal function remained stable. Urinary continence was satisfactory during the day and night with voluntary voiding. Our experience showed that radical cystectomy and orthotopic ileal neobladder reconstruction in transplant patients with stable renal function is a safe and effective way to provide better quality of life, satisfactory urinary diversion and preservation of renal function simultaneously.
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Affiliation(s)
- Jianwen Wang
- The Division of Urology, Beijing Organ Transplantation Center, Beijing ChaoYang Hospital, Capital University of Medical Sciences, Beijing, China
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