Impact of posterior urethral valves on pediatric renal transplantation: a single-center comparative study of 297 cases

Pediatr Transplant. 2011 Aug;15(5):482-7. doi: 10.1111/j.1399-3046.2011.01484.x. Epub 2011 May 22.

Abstract

Objective: This is a retrospective long-term evaluation of the renal allografts and bladder functions in pediatric recipients who had posterior urethral valves (PUV).

Patients and methods: Between March 1976 and February 2009, 2033 live-donor renal transplantations were carried out in our center. Of these, 297 (14.2%) were in the pediatric age (≤18 yr). The pediatric recipients included 20 (6.7%) boys who developed end-stage renal disease as a late complication of PUV and recognized as group I while the remaining 277 pediatric recipients were defined as group II. Demographic characteristics, post-transplant complications and graft function were compared among both groups. Patient and graft survivals of both groups were also estimated. Moreover, the bladder function of the study group was evaluated by urodynamic studies.

Results: Patients with PUV (group I) were significantly younger than group II. Although the overall rate of urological complications in both groups was essentially similar, the incidence of urinary fistulae and urinary tract infection were higher in group I. The mean (SD) follow up periods for group I and II were 4.7 (4.1) and 6.4 (4.8) yr, respectively. At last follow up the serum creatinine values were similar among patients of both groups. Moreover, there were no differences in graft or patient survival at five and 10 yr. Detrusor over-activity could be elicited in only one of group I patients. Schafer nomogram showed non-obstructed pattern in all cases.

Conclusion: Good functional outcome could be achieved for patients with PUV if renal transplantation is necessary. Pre-transplant surgical procedures may be required such as nephroureterectomy, cytoplasty or injection of refluxing ureters. A robust anti-refluxing uretero-vesical anastomosis is important, and can be achieved by a Lich-Gregoir procedure.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Creatinine / blood
  • Female
  • Humans
  • Infant, Newborn
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / methods*
  • Male
  • Postoperative Complications
  • Time Factors
  • Transplantation, Homologous / methods
  • Treatment Outcome
  • Urethra / surgery*
  • Urodynamics

Substances

  • Creatinine