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Nakamura N, Emoto T, Fukuhara Y, Miyazaki T, Aoyagi C, Gunge N, Okabe Y, Matsuzaki H, Fujikawa A, Nakagawa C, Tachibana M, Yamasaki F, Tominaga K, Tsubouchi K, Aso S, Haga N. Factors related to nocturia-specific quality of life in renal transplantation patients. Low Urin Tract Symptoms 2024; 16:e12517. [PMID: 38693053 DOI: 10.1111/luts.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/30/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Patients following renal transplantation (RTX) may experience nocturia exacerbation due to polyuria and reduced bladder capacity, thereby impacting the specific quality of life (QOL) associated with nocturia. The present study aims to investigate factors associated with the deterioration of nocturia-specific QOL in RTX patients. METHODS The study cohort comprised 59 consecutive patients who had undergone successful RTX. Nocturia-related QOL questionnaires (N-QOL) were employed to evaluate the specific QOL related to nocturia. The Bother/Concern and Sleep/Energy domains of the N-QOL were also assessed. The primary outcome measure was to explore factors related to the aggravation of nocturia-specific QOL in patients post-RTX. RESULTS The mean nocturia frequency post-RTX was 1.3 ± 1.0. Univariate and multivariate analyses revealed a significant reduction in the Bother/Concern domain score associated with increased nocturia (p = .042). Aging significantly decreased the total N-QOL score and the Sleep/Energy domain score (p = .001 and .0002, respectively). Prolonged duration after RTX significantly reduced the scores of both the Sleep/Energy domain and the Bother/Concern domain (p = .018 and .037, respectively). However, the duration of dialysis prior to RTX was not significantly associated with the total score or subdomains of N-QOL. CONCLUSIONS Nocturia-specific QOL affected not only the nocturia itself, but also aging and the prolonged duration after RTX. Thus, comprehensive approaches to the RTX patients were needed to improve the Nocturia-specific QOL in RTX patients.
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Affiliation(s)
- Nobuyuki Nakamura
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Taiki Emoto
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuichiro Fukuhara
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Chikao Aoyagi
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Aiko Fujikawa
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Chizuru Nakagawa
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Masahiro Tachibana
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Fumihiro Yamasaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kosuke Tominaga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuna Tsubouchi
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shintaro Aso
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Puliyanda D, Barday Z, Barday Z, Freedman A, Todo T, Chen AKC, Davidson B. Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics. Semin Nephrol 2023; 43:151442. [PMID: 37949683 DOI: 10.1016/j.semnephrol.2023.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Kidney transplantation is the treatment of choice for all patients with end-stage kidney disease, including pediatric patients. Graft survival in pediatrics was lagging behind adults, but now is comparable with the adult cohort. Although many of the protocols have been adopted from adults, there are issues unique to pediatrics that one should be aware of to take care of this population. These issues include recipient size consideration, increased incidence of viral infections, problems related to growth, common occurrence of underlying urological issues, and psychosocial issues. This article addresses the similarities and differences in renal transplantation, from preparing a patient for transplant, the transplant process, to post-transplant complications.
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Affiliation(s)
- Dechu Puliyanda
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA.
| | - Zibya Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Zunaid Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Freedman
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Tsuyoshi Todo
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Allen Kuang Chung Chen
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Bianca Davidson
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Martin SP, Lum C, Kushwaha K, Goldbeck C, Kwon Y, Etesami K, Kim J, Emamaullee J, Zielsdorf SM. Evaluation of technical urinary tract complications in kidney transplantation recipients with a prolonged dialysis history. Surgery 2023:S0039-6060(23)00088-0. [PMID: 37031052 DOI: 10.1016/j.surg.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND The kidney transplant waiting list continues to expand, resulting in prolonged dialysis times exceeding 8 years before transplantation in some regions. The relationship between long-term dialysis and urinary tract complications after kidney transplant remains largely unexplored. This study aims to evaluate post-kidney transplant complications in patients with a history of prolonged dialysis. METHODS A single-center, retrospective cohort study of patients maintained on dialysis ≥8 years before kidney transplant between January 2000 and July 2020 was conducted. Clinical variables, including demographics and comorbidities, were reviewed. The primary objective was the development of a technical urinary tract complication. Secondary outcomes included any postoperative complication by type, stratified by medical and surgical complications. RESULTS Overall, 376 patients met the inclusion criteria. The mean pre-kidney transplant dialysis time was 10.2 ± 2.6 years. The majority (65.7%) of the study participants were anuric. Four patients (1.1%) experienced a urine leak, and 8 patients (2.1%) had a ureteral stricture. Any complication was observed in 111 (29.5%) patients, with urinary tract infections being the most common. Urinary catheters remained in place for a median of 4 (3, 5) days. Drains were commonly used (62.8%) for a median of 5 (4, 6) days. CONCLUSION In our large, single-center experience with kidney transplants in high-risk patients with prolonged dialysis and anuria, the technical urinary tract complications rate remained low. With the current literature consisting of small cohorts and having relatively short pre-kidney transplant dialysis periods, our analysis addresses the shortcomings of the literature while suggesting that this patient population may not truly be "high risk."
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Affiliation(s)
- Sean P Martin
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Christine Lum
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kara Kushwaha
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Cameron Goldbeck
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Yong Kwon
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Kambiz Etesami
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Jim Kim
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Juliet Emamaullee
- Department of Surgery, University of Southern California, Los Angeles, CA. https://twitter.com/DrEmamaullee
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4
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Hori S, Torimoto K, Tomizawa M, Yoneda T, Inoue K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Tanaka N, Fujimoto K. Impact of Nocturnal Polyuria and Sleep Quality in Kidney Transplant Recipients With Nocturia. Transplant Proc 2023:S0041-1345(23)00100-8. [PMID: 36934056 DOI: 10.1016/j.transproceed.2023.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND To investigate the quality of life (QOL) of patients with nocturia after kidney transplantation (KT) and the association between nocturnal polyuria and sleep quality. METHODS In a cross-sectional study, a patient who consented was evaluated using the following items: international prostate symptom QOL score, nocturia-quality of life score, overactive bladder symptom score, Pittsburgh sleep quality index, bladder diary, uroflowmetry, and bioimpedance analysis. Clinical and laboratory data were obtained from medical charts. RESULTS Forty-three patients were included in the analysis. Approximately 25% of patients urinated once at night, and 58.1% had nocturia twice. Nocturnal polyuria was observed in 86.0% of patients, and overactive bladder was observed in 23.3% of patients. According to the Pittsburgh sleep quality Index, 34.9% of patients had poor sleep quality. Multivariate analysis revealed that patients with nocturnal polyuria tended to have a high estimated glomerular filtration rate (P = .058). On the other hand, multivariate analysis for poor sleep quality revealed that high body fat percentage and low nocturia-quality of life total score were independently correlated factors (P = .008 and P = .012, respectively). Furthermore, the patients with nocturia ≥3/night were significantly older than those with nocturia ≤2/night (P = .022). CONCLUSION Nocturnal polyuria, poor sleep quality, and aging may decrease the QOL of patients with nocturia after KT. Further investigations, including optimal water intake and interventions, can lead to better management after KT.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | | | | | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Nara, Japan
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Nara, Japan; Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
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Koga S, Yamanaga S, Hidaka Y, Tanaka K, Kaba A, Toyoda M, Ochiai S, Takano Y, Yamamoto Y, Inadome A, Yokomizo H. Influence of Graft Ureter Length, a Donor-Related Factor, on Urinary Tract Infections After Living-Donor Kidney Transplantation: A Single-Center Analysis of 211 Cases. Transpl Int 2022; 35:10754. [PMID: 36406779 PMCID: PMC9666398 DOI: 10.3389/ti.2022.10754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Urinary tract infection (UTI) occurs in 25% of recipients of living-donor kidney transplantation (LDKT). Female sex, age, and anatomical abnormalities have been reported as recipient-related risk factors for UTI after LDKT; few studies have reported donor-related factors. We retrospectively examined UTI occurrence within 5 years of transplantation in recipients (n = 211) who underwent LDKT at our hospital between April 2011 and April 2021. All nephrectomies were performed using a retroperitoneal pure laparoscopic approach. The ureter was dissected at the lower level of the common iliac artery and trimmed to the shortest length, enough to reach the bladder using extra vesicular ureterocystoneostomy with a 3 cm submucosal tunnel. Twenty-nine recipients (13.7%) developed UTI within 5 years, and the median time to onset was 40.0 days. After adjusting for the well-known factors, including recipient sex, graft ureter length was an independent factor for UTI occurrence (HR 1.25, 95% CI 1.02∼1.53, p = 0.028) in the multivariate Cox regression analysis. The long ureter is usually trimmed, and the widest part is used for anastomosis, which may increase the possibility of reflux from the bladder to the ureter in the standard technique. The ureter length may be associated with the incidence of UTI after LDKT.
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Affiliation(s)
- Shoma Koga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akari Kaba
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shintaro Ochiai
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yuichi Takano
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yasuhiro Yamamoto
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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6
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Drudi FM, Angelini F, Bertolotto M, Granata A, Di Pierro GB, Lai Q, D'Ermo G, Pretagostini R, Cantisani V. Role of Contrast-Enhanced Voiding Urosonography in the Evaluation of Renal Transplant Reflux - Comparison with Voiding Cystourethrography and a New Classification. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e73-e80. [PMID: 33434942 DOI: 10.1055/a-1288-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients. THE AIM of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system. MATERIALS AND METHODS From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS. RESULTS In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2. CONCLUSION Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed.
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Affiliation(s)
| | - Flavia Angelini
- Department of Radiology, University La Sapienza, Rome, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, "St. Giovanni di Dio" Hospital, Agrigento, Italy
| | | | - Quirino Lai
- Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Renzo Pretagostini
- Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
| | - Vito Cantisani
- Department of Radiology, University La Sapienza, Rome, Italy
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7
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Nardelli L, Scalamogna A, Messa P, Gallieni M, Cacciola R, Tripodi F, Castellano G, Favi E. Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice? Medicina (B Aires) 2022; 58:medicina58020214. [PMID: 35208541 PMCID: PMC8875254 DOI: 10.3390/medicina58020214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 12/28/2022] Open
Abstract
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.
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Affiliation(s)
- Luca Nardelli
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Antonio Scalamogna
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Piergiorgio Messa
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy;
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Roberto Cacciola
- Department of Surgical Sciences, Università di Tor Vergata, 00133 Rome, Italy;
| | - Federica Tripodi
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Evaldo Favi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-3666036167
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8
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Allograft Vesicoureteral Reflux after Kidney Transplantation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010081. [PMID: 35056389 PMCID: PMC8780114 DOI: 10.3390/medicina58010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 01/06/2023]
Abstract
Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.
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9
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Abstract
Due to atrophic bladder, patients undergoing long-term dialysis experience vesicoureteral reflux and complicated urinary tract infections after kidney transplantation. A 58-year-old woman underwent living donor kidney transplantation after 41 years of dialysis. She had no contraindications, with good cardiac function and minimal artery calcification despite the long history of hemodialysis. Immunosuppression was initiated with tacrolimus, mycophenolate mofetil, prednisolone, and basiliximab. Ureteroneocystostomy with an antireflux technique was carefully conducted as her bladder volume was 15 mL. The postoperative clinical course was uneventful with immediate graft function. The bladder volume gradually increased to 81 mL at discharge, 3 weeks postoperatively. The patient was initially depressed due to frequent urination early post-transplant but recovered soon after as the bladder volume gradually increased to 400 mL. The patient has not yet reported a urinary tract infection episode. This case highlights living donor kidney transplantation-induced recovery of bladder function with careful ureteroneocystostomy, despite the long dialysis history.
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10
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Apel H, Rother U, Wach S, Schiffer M, Kunath F, Wullich B, Heller K. Transplant Ureteral Stenosis after Renal Transplantation: Risk Factor Analysis. Urol Int 2021; 106:518-526. [PMID: 34781290 DOI: 10.1159/000519787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The results of kidney transplants have improved dramatically in recent years, leading to reduced morbidity and mortality. Despite continuous improvements, urological complications occur at a rate of 2.6%-15%. Ureteral stenosis of graft ureters is the most common complication, with a probability of 0.5%-6.3%. This study aimed to determine the incidence of ureteral stenosis after kidney transplantation and identify risk factors that distinguish transplant patients with and without ureteral stenosis. METHODS This study retrospectively analyzed patients who had undergone kidney transplantation at the Department of Urology of the Friedrich-Alexander University Erlangen-Nuremberg between 2001 and 2015. Forty-seven patients developed ureteral stenosis during the operation. Most of the ureteral stenosis cases occurred in the first 4 months after transplantation. Kaplan-Meier analysis and the log-rank test were used to calculate the cumulative risk, and the Mann-Whitney U test was used nonparametrically. The significance level was set at p < 0.05. RESULTS Statistical analysis showed that residual diuresis (p = 0.008), cold ischemia time (CIT) (p = 0.040), the body mass index (p = 0.027), and donor serum creatinine value (p = 0.039) showed a significantly different distribution between recipients with or without ureteral stenosis after kidney transplantation. In multivariate Cox's regression modeling, residual diuresis and the donor serum creatinine level were identified as the only independent predictors of patients' stenosis-free survival. CONCLUSION Urological complications not diagnosed and treated in time endanger the success of kidney transplantation. After evaluating the kidney transplantation data of the patients at the Transplant Center Erlangen-Nuremberg from 2001 to 2015, residual diuresis, CIT, the body mass index, and donor serum creatinine value were found to influence the development of ureteral stenosis.
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Affiliation(s)
- Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Surgery, Vascular Surgery Section, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mario Schiffer
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Heller
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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11
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Sevmis M, Kilercik H, Aktas S, Alkara U, Demir ME, Sevmis S. Results of Haberal's Corner-Saving Ureteral Anastomosis Technique for Renal Transplantation: A Retrospective Study. Transplant Proc 2020; 53:814-817. [PMID: 33261850 DOI: 10.1016/j.transproceed.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urological complications after renal transplantation (RT), including urine leaks, remain the most common type of surgical complications in the early post-transplant period. In this study we evaluated 324 consecutive RTs recipients in whom Haberal's corner-saving anastomosis technique was used for ureteroneocystostomy. MATERIAL AND METHODS Since January 2018, 461 RTs were performed at our center. Haberal's corner-saving anastomosis technique was used in 324 of these 461 RTs and the effectiveness of the technique was analyzed retrospectively. There were 115 female patients and 209 male patients, with a mean age of 42.1 ± 13.9 years. The most common etiology resulting in RT was hypertension among the recipients. RESULTS We observed 8 (2.4%) ureteral complications in 7 recipients as follows: ureteral stenosis in 2 recipients (0.6%), anastomotic leaks in 1 (0.3%), concomitant leak-stenosis in 1 (0.3%), and vesicoureteral reflux in 3 (0.9%). Six complications were treated with interventional radiological techniques and 2 were treated surgically. There was no graft and patient loss in the event of urological complications. CONCLUSION Because of the low complication rate, we believe that Haberal's corner-saving ureteral anastomosis technique is a safe method for performing a ureteroneocystostomy.
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Affiliation(s)
- Murat Sevmis
- Department of General Surgery and Organ Transplantation, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Hakan Kilercik
- Department of Anesthesiology and Reanimation, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Sema Aktas
- Department of General Surgery and Organ Transplantation, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Utku Alkara
- Department of Interventional Radiology, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Mehmet Emin Demir
- Department of Nephrology and Organ Transplantation, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Sinasi Sevmis
- Department of General Surgery and Organ Transplantation, Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Istanbul, Turkey.
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12
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Morizawa Y, Satoh H, Iwasa S, Sato A, Aoki Y, Harada R, Hamada R, Hataya H. Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients. Int J Urol 2020; 27:1008-1012. [PMID: 32789949 DOI: 10.1111/iju.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the frequency of vesicoureteral reflux, and the relationship of pretransplant decreased bladder capacity and post-transplant vesicoureteral reflux in children undergoing kidney transplantation. METHODS A voiding cystourethrography was carried out in 172 pediatric kidney transplantation recipients before, and 4 months after, transplantation to evaluate bladder capacity and vesicoureteral reflux. The correlation of post-transplant vesicoureteral reflux with pretransplant bladder capacity, vesicoureteral reflux in the native kidney and the method of ureteral reimplantation (intravesical/extravesical) was analyzed. Atrophic bladder was defined as having ≤50% functional bladder capacity (age in years + 2) × 25 (mL) or ≤150 mL in patients aged >10 years. RESULTS Bladder capacity increased remarkably after transplantation in both post-transplant vesicoureteral reflux- group (from 180 to 253 mL) and vesicoureteral reflux+ group (from 82 to 171 mL). Voiding cystourethrography showed vesicoureteral reflux in 12 cases of kidney transplantation (7%; grade 1: 2, grade 2: 3, grade 3: 7). Pretransplant atrophic bladder was an independent risk factor of post-transplant vesicoureteral reflux (P = 0.004, hazard ratio 9.5). There was no difference in renal function between the vesicoureteral reflux- group and vesicoureteral reflux+ group at 4 months to 5 years post-transplantation. CONCLUSIONS Pretransplant atrophic bladder is a risk factor of post-transplant vesicoureteral reflux in pediatric patients. However, bladder capacity can remarkably increase after transplantation, and kidney function in the post-transplant vesicoureteral reflux+ group is stable.
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Affiliation(s)
- Yosuke Morizawa
- Departments of, Department of, Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroyuki Satoh
- Departments of, Department of, Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shun Iwasa
- Departments of, Department of, Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Atsuko Sato
- Departments of, Department of, Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yujiro Aoki
- Departments of, Department of, Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Ryoko Harada
- Department of, Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Riku Hamada
- Department of, Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of, Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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13
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Kisou Y, Inoue T, Nishijima K, Huang M, Yamamoto R, Koizumi A, Nara T, Numakura K, Saito M, Narita S, Satoh S, Habuchi T. Candidate genes involved in the defunctionalization and refunctionalization of the urinary bladder induced by bladder anuria and reperfusion. Neurourol Urodyn 2020; 39:1653-1666. [PMID: 32542707 DOI: 10.1002/nau.24427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
AIMS We develop a novel rabbit urinary diversion model of bladder defunctionalization due to bladder anuria followed by refunctionalization due to urine reperfusion to investigate the molecular biological background. To validate the results, we used reverse transcription-polymerase chain reaction (RT-PCR) to analyze human specimens from defunctionalized bladders in patients receiving dialysis before kidney transplantation. METHODS Female rabbits were divided into three groups: control, defunctionalized, and refunctionalized. The bilateral ureters were anastomosed to vagina in the defunctionalized and refunctionalized groups at 0 weeks. In the refunctionalized group, the unilateral ureter was reanastomosed to the bladder at 8 weeks. RESULTS The capacity and compliance of the rabbit bladder in the refunctionalized group were significantly lower than those in the control group at 8 weeks and higher than those in the defunctionalized group at 14 weeks. The significant downregulation of IGFBP2, UPK1B, and CST6 in the defunctionalized group compared with that in the control groups, and the significant downregulation of AGTR2 in the refunctionalized group compared with that in the defunctionalized group in the rabbit bladder-muscle DNA microarray were validated by RT-PCR. Human bladder muscle indicated significant downregulation of UPK1B and CST6 and significant downregulation of IGFBP2 in the defunctionalized group, which is consistent with both rabbit bladder-muscle DNA microarray and rabbit bladder RT-PCR results. CONCLUSIONS The present study using novel model of bladder defunctionalization followed by refunctionalization indicated the consistent downregulation of UPK1B and CST6 in muscle and the consistent downregulation of IGFBP2 in mucosa in process of bladder defunctionalization, which was validated by human specimens.
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Affiliation(s)
- Yusuke Kisou
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazutoshi Nishijima
- Animal Research Laboratory, Department of Urology, Bioscience Education-Research Support Center, Akita University, Akita, Japan
| | - Minguo Huang
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Koizumi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeru Satoh
- Department of Urology, Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
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14
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Alam Z, VanderBrink BA, Brewer N, Hooper D, Tiao G, Alonso M, Nathan J, DeFoor WR, Sheldon C, Reddy PP. Is anuria prior to pediatric renal transplantation associated with poor allograft outcomes? Pediatr Transplant 2019; 23:e13453. [PMID: 31066481 DOI: 10.1111/petr.13453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/20/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anuria from end-stage renal disease leads to a defunctionalized bladder and may pose technical challenges at the time of renal transplantation. Anuria's effect on bladder function after renal transplantation is considered to be minimal in adults, although a paucity of evidence is available in children. The purpose of this study was to examine the effects of anuria prior to pediatric renal transplantation for ESRD due to medical renal disease on allograft outcome. METHODS We performed a retrospective review of pediatric patients who underwent renal transplantation for medical renal disease at our institution between 2005 and 2016. Demographics and clinical data were assessed. We also compared GFR at 1 year post-transplant for medical renal patients with history of anuria and those without. RESULTS Twenty-one patients fulfilled our inclusion criteria with median duration of anuria was 10 months. Preoperative VCUG was available in five patients and their bladder capacity was 29% of expected bladder capacity for age (range 8%-41%). Anticholinergic therapy was prescribed in six patients (28%) for a mean duration of 5 months (range 1-16 months). Comparison of GFR at 1 year post-transplant in anuria group and those without anuria showed no difference (69 vs 75 mL/min, P = 0.37). No correlation was observed between duration of anuria and post-transplant GFR. CONCLUSION The majority of children in our pretransplant anuria cohort did not develop bladder dysfunction after renal transplantation. No difference was observed between GFR at 1 year when comparing anuric to non-anuric transplant recipients of medical renal disease etiology.
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Affiliation(s)
- Zaheer Alam
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brian A VanderBrink
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nathalie Brewer
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Hooper
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Greg Tiao
- Division of Transplant Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria Alonso
- Division of Transplant Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jaimie Nathan
- Division of Transplant Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - W Robert DeFoor
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Curtis Sheldon
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Pramod P Reddy
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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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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16
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Chen SF, Lee CL, Kuo HC. Changes in sensory proteins in the bladder urothelium of patients with chronic kidney disease and end-stage renal disease. Low Urin Tract Symptoms 2018; 11:O202-O208. [PMID: 30198096 DOI: 10.1111/luts.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) frequently have lower urinary tract symptoms, such as frequency, urgency, or bladder pain. This study evaluated sensory protein expression in the bladder urothelium of patients with CKD or ESRD. METHODS Twenty-seven patients with ESRD or CKD and urodynamically proven detrusor underactivity (DU; n = 8) or bladder oversensitivity (n = 19) were enrolled in the study. These patients, and 10 controls, underwent cystoscopic biopsies of the urothelium. Western blotting analysis was used to examine the expression of sensory proteins, namely purinergic P2X3 , muscarinic M2 and M3 , and β3 -adrenergic (AR) receptors, as well as inducible (i) and epithelial (e) nitric oxide synthase (NOS), in tissue samples. Expression was compared between CKD or ESRD patients and controls. RESULTS P2X3 receptor expression was lower, whereas β3 -AR was expression higher in the bladder urothelium of the patient group (ESRD and CKD combined) compared with controls. In addition, compared with controls, CKD patients had significantly lower P2X3 receptor expression, whereas ESRD patients had significantly higher M3 receptor expression. There were no significant differences in M2 receptor, eNOS, and iNOS expression between ESRD or CKD patients and controls. Patients with DU had significantly higher M2 and M3 receptor expression. There were no significant differences in the expression of any protein between ESRD and CKD patients, regardless of the presence of bladder pain or anuria. CONCLUSION Significantly decreased P2X3 receptor and increased β3 -AR expression are seen in the bladder urothelium of patients with ESRD or CKD. The expression of these sensory proteins is not associated with decreased bladder capacity or anuria status in patients with ESRD or CKD.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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17
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Kido K, Hatakeyama S, Hamano I, Yamamoto H, Imai A, Yoneyama T, Hashimoto Y, Koie T, Fujita T, Murakami R, Tomita H, Suzuki T, Narumi S, Ohyama C. Partial Cystectomy of Paraganglioma of the Urinary Bladder Before Living Kidney Transplantation: Case Report. Transplant Proc 2018; 50:898-901. [PMID: 29661460 DOI: 10.1016/j.transproceed.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation. CASE PRESENTATION A 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing. Cystoscopy revealed a submucosal tumor on the right side of the bladder. The patient experienced a hypertensive crisis during transurethral resection of the bladder tumor. Endocrinologic and pathologic examinations confirmed the diagnosis of paraganglioma in the urinary bladder. A partial cystectomy was performed before kidney transplantation. Nine months after partial cystectomy, the patient underwent AB0-incompatible living kidney transplantation from his spouse. No disease recurrence or graft rejection was observed 12 months after the transplantation. CONCLUSIONS To our knowledge, this is the 1st report on the management of paraganglioma in the urinary bladder before living kidney transplantation. Kidney transplantation after partial cystectomy is an option that may be considered in patients with paraganglioma of the urinary bladder, with careful observations of bladder function and vesicoureteral reflux to the grafts.
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Affiliation(s)
- K Kido
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - S Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - I Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Imai
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Fujita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - R Murakami
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Suzuki
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - S Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - C Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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18
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Influence of CYP3A5 genetic differences in tacrolimus on quantitative interstitial fibrosis and long-term graft function in kidney transplant recipients. Int Immunopharmacol 2018; 58:57-63. [PMID: 29550576 DOI: 10.1016/j.intimp.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 01/03/2023]
Abstract
The impact of CYP3A5 polymorphisms on clinical outcomes is controversial. The present study investigated the impact of CYP3A5 genetic differences on the development of interstitial fibrosis (IF) from 0 h to 1 year post-transplantation in biopsy sections from 96 living kidney recipients under the same target trough regimen of tacrolimus. The relationships between CYP3A5 polymorphisms and long-term graft function and death-censored graft survival were also examined. A quantitative analysis of IF was performed using computer-assisted imaging on virtual slides. Percent IF (%IF) in the cortical region at 0 h was defined as the baseline, and increases in the ratio of %IF 1 year post-transplantation were calculated. The relationships between CYP3A5 genetic differences and the development of IF, the incidence of clinical events, and the long-term function and death-censored survival of grafts were assessed. The mean increase in the ratio of %IF from 0 h to 1 year was 1.38 ± 0.74-fold. Despite therapeutic drug monitoring (TDM), trough levels of tacrolimus were lower in carriers with the CYP3A5*1 allele (expressers) than in those with the CTP3A5*3/*3 genotype (non-expressers) throughout the 1-year post-transplantation period. However, CYP3A5 genetic differences were not associated with the development of IF, any clinical events, or the long-term function and survival of grafts. The clinical impact of CYP3A5 genetic differences may be small under the current immunosuppressive regimen consisting of mycophenolate mofetil, steroids, basiliximab, and lower target trough levels of tacrolimus with suitable TDM in a low immunological risk population.
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Abstract
BACKGROUND Vesicoureteral reflux (VUR) is frequently found after transplantation, but its impact on graft function, urine tract infection, and graft loss remains uncertain. Therefore our objective was to evaluate the effects of VUR on the outcome of renal transplantation. MATERIAL AND METHODS We included 1008 adult renal transplant recipients of whom a 1-week posttransplant voiding cystourethrogram was available. Study end points included occurrence of bacteriuria, renal function, and graft survival. RESULTS In total, 106 (10.5%) of 1008 graft recipients had a diagnosis of VUR on voiding cystography. The incidence of bacteriuria was comparable in the reflux and nonreflux group (17% vs 17.4%, P = .91). There was no significant difference in renal function at 3 months and 1 year in patients with and without VUR. One- and 5-year graft survival in patients with VUR was 85.8% and 82.1% compared to 87.3% and 83.0% in patients without VUR ( P = .68 and P = .80). CONCLUSION Posttransplant VUR has no correlations with early bacteriuria, renal function, and graft survival.
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Affiliation(s)
- Nina M Molenaar
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Robert C Minnee
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- 2 Renal Transplant Unit, Department of Nephrology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Mirza M Idu
- 1 Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
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20
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Hotta K, Miura M, Wada Y, Fukuzawa N, Iwami D, Sasaki H, Seki T, Harada H. Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation. Int J Urol 2017; 24:314-319. [PMID: 28190268 DOI: 10.1111/iju.13297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 12/26/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the risk for urological complications after kidney transplantation at a single medical center in Japan. METHODS In the present study, 408 kidney recipients (255 men, 153 women) were enrolled. There were 349 living and 59 deceased donors. The average age of the recipients was 42.5 ± 13.5 years, and the average pretransplant dialysis period was 71.8 ± 88.2 months. Ureteroneocystostomy was carried out on 347 patients, and ureteroureterostomy on 61 patients. We investigated the relationship between pretransplant duration of dialysis and bladder capacity, and examined the risk factors for urological complication. We also evaluated the incidence of vesicoureteral reflux in 191 recipients who underwent ureteroneocystostomy during transplantation. RESULTS The preoperative duration of dialysis therapy showed a significant negative correlation with bladder capacity (R2 = 0.33, P < 0.001). The overall urological complication rate was 3.4% (14 patients), including urinary leakage (12 patients) and ureteral stricture (two patients). Univariate analysis showed that atrophic bladder, long-term dialysis therapy, deceased donor and ureteroureterostomy were associated with a higher incidence of urological complications (odds ratio 8.05, 4.43, 3.42 and 3.35; P < 0.01, P = 0.01, P = 0.04 and P = 0.04, respectively). Furthermore, multivariate analysis showed that atrophic bladder was the only significant factor associated with urological complications (odds ratio 10.37; P = 0.01). Among 191 recipients, vesicoureteral reflux was observed in 32 (16.8%). The incidence of vesicoureteral reflux was significantly higher in patients with atrophic bladder. CONCLUSIONS Bladder atrophy in renal transplant recipients after long-term dialysis therapy is associated with a higher risk of urological complications.
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Affiliation(s)
- Kiyohiko Hotta
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Masayoshi Miura
- Department of Renal Transplantation Surgery, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Yoshiki Wada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Daiki Iwami
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Hajime Sasaki
- Department of Urology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Toshimori Seki
- Department of Urology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
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21
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Vyas S, Roberti I. Anuria since birth: does it impact outcome of kidney transplant in infants? Pediatr Transplant 2016; 20:1032-1037. [PMID: 27495879 DOI: 10.1111/petr.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Kidney transplantation (txp) in infants has recently made much progress but provides a unique challenge in infants anuric since birth. Little data exists on outcome of renal txp recipients with anuria since birth. Retrospective chart review was done for outcome of 27 children with wt ≤15 kg and they were divided into two groups: Group A (N=21) with urine output and Group B (N=6) anuric since birth had their urological complications and long-term outcome compared. Median age at the time of txp 18 vs 23 months, mean wt 10.8 vs 11.8 kg, and mean ht 77 cm in both, mean follow-up post-txp: 9.4 vs 5.6 years, and neurological problems were noted in 48% and 33% in Group A and Group B. There was no graft thrombosis or post-transplant lymphoproliferative disease and only two rejections. Anuric Group B were older, had more post-txp urological surgeries (66% vs 19%) and UTIs (66% vs 38%) compared to Group A. The overall graft survival at 1, 5, and 10 years was 96%, 86%, and 70%; patient survival at 1, 5, and 10 years was 96%, 85%, and 85%. Long-term graft outcomes in small children, anuric prior to txp, were excellent despite higher rates for UTIs and urological complications.
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Affiliation(s)
- Shefali Vyas
- Barnabas Health, Children's Kidney Center, West Orange, NJ, USA
| | - Isabel Roberti
- Barnabas Health, Children's Kidney Center, West Orange, NJ, USA
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22
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Troubles du bas appareil urinaire et de la statique pelvienne chez les candidats et receveurs d’une transplantation rénale. Prog Urol 2016; 26:1114-1121. [DOI: 10.1016/j.purol.2016.09.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
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Inoue T, Satoh S, Obara T, Saito M, Numakura K, Narita S, Tsuchiya N, Habuchi T. Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result of long-term dialysis after kidney transplantation. Int J Urol 2016; 23:694-700. [DOI: 10.1111/iju.13122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Takamitsu Inoue
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Shigeru Satoh
- Center for Kidney Disease and Transplantation; Akita University Graduate School of Medicine; Akita Japan
| | - Takashi Obara
- Department of Urology; Japanese Red Cross Akita Hospital; Akita Japan
| | - Mitsuru Saito
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Kazuyuki Numakura
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Shintaro Narita
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Norihiko Tsuchiya
- Department of Urology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
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Nohara T, Matsuyama S, Shima T, Kawaguchi S, Seto C. Holmium Laser Enucleation of the Prostate With Percutaneous Nephrostomy Into the Transplanted Kidney in Patient With Severe Benign Prostatic Hyperplasia With Vesicoureteral Reflux - A Case Report. Urol Case Rep 2015; 4:33-5. [PMID: 26793574 PMCID: PMC4719790 DOI: 10.1016/j.eucr.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/03/2015] [Indexed: 11/13/2022] Open
Abstract
A 66-year-old male, who had received renal transplantation 10 years before, was admitted to our hospital with urinary retention. The prostate volume was 169.2 ml. Furthermore, grade 5 vesicoureteral reflux (VUR) was shown in the cystography. Holmium laser enucleation of prostate (HoLEP) was performed, and percutaneous nephrostomy to the transplanted kidney was performed simultaneously to prevent from severe perioperative infection. After that, renal graft function improved and no urinary retention reoccurred, although surgical repair against VUR was necessary 10 months after HoLEP. We conclude that surgical treatment for BPH after kidney transplantation should be strongly considered with care for infections.
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Affiliation(s)
- Takahiro Nohara
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Satoko Matsuyama
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Shohei Kawaguchi
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
| | - Chikashi Seto
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama, Toyama 930-8550, Japan
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Papel de la cistouretrografía miccional en el protocolo de trasplante renal: ¿reemplaza al urólogo? UROLOGÍA COLOMBIANA 2015. [DOI: 10.1016/j.uroco.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Urinary tract reconstruction using uretero-ureteral end-to-side anastomosis in kidney transplant recipients. Transplant Proc 2015; 47:359-62. [PMID: 25769573 DOI: 10.1016/j.transproceed.2014.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/31/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND In kidney transplant recipients, the most widely used method for the reconstruction of the urinary pathway is ureteroneocystostomy, which may be difficult in cases with disused atrophic bladder. In this study, we evaluated kidney transplant recipients who underwent uretero-ureteral end-to-side anastomosis (UUA) in urinary reconstruction due to disused atrophic bladder. METHODS To clarify the effectiveness of this method, we retrospectively reviewed the clinical records of kidney transplant recipients in our hospital. RESULTS A total of 9 recipients with urinary reconstruction using UUA were evaluated. All of these patients had a history of long-term hemodialysis before transplantation, accompanied by complete anuria and small capacity of the bladder. In 4 patients, cranial native ureter was ligated, whereas it was not ligated in the remaining 5 patients. In 2 of 4 patients with cranial ligation, hydronephrosis developed in the native kidney with no further treatment being required. No patients experienced urinary tract complications including hydronephrosis in the graft, urine extravasation, or urinary tract infection in the follow-up period (757.6 ± 491.3 days). Allograft function was maintained well in all patients (serum creatinine level, 1.08 ± 0.23 mg/dL). CONCLUSIONS Although UUA is not a routine method of urinary reconstruction in kidney transplantation, it can be safely performed and should be a surgical option, especially for recipients with disused atrophic bladder. The ligation of cranial native ureter may lead to hydronephrosis of the native kidney, and it is tentatively concluded that UUA without native ureteral ligation is clinically feasible.
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Debilitating Lower Urinary Tract Symptoms in the Post-Renal Transplant Population Can Be Predicted Pretransplantation. Transplantation 2013; 95:589-94. [DOI: 10.1097/tp.0b013e3182782f7e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Improvement of urinary dysfunction after kidney transplantation by administration of the antimuscarinic agent--prospective randomized controlled study. Transplantation 2012; 93:597-602. [PMID: 22245877 DOI: 10.1097/tp.0b013e318244f799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bladder dysfunction after kidney transplantation (KTx) impairs the patients' quality of life. We examined the bladder function status perioperatively in patients undergoing KTx and performed a randomized prospective study to determine the efficacy of an antimuscarinic agent, solifenacin, in ameliorating the bladder dysfunction after KTx. METHODS The subjects in this study were 33 patients who underwent KTx at our institution. The patients were divided into two groups: group 1 (n=18), composed of patients who were not treated with any antimuscarinic agent, and group 2 (n=15), composed of patients treated with an antimuscarinic agent. We investigated the actual bladder function status of these patients before and after KTx by the following two methods: (1) video water cystometry and (2) questionnaire study using the Overactive Bladder Symptom Score and King's Health Questionnaire. RESULTS The cystometry study revealed a significantly greater increase of the maximum cystometric capacity in group 2 than in group 1 (173.0±60.7 mL in group 1 and 260.1±51.0 mL in group 2 [P=0.005]) after KTx. In the questionnaire surveys, the decreases in the scores for all domains were observed 6 weeks after KTx. The scores in group 2 tended to be lower than those in group 1. CONCLUSION In all of our patients, the bladder dysfunction status improved dramatically after KTx. In addition, our results suggest that administration of the antimuscarinic agent, solifenacin, may contribute to improvement of the quality of life of patients undergoing KTx.
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