Urological complications and urinary tract infections depending on urinary outflow in pediatric patients after kidney transplantation
Dorota Broniszczak-Czyszek1, Hor Ismail1, Katarzyna Woźniak-Pankowska1, Marek Szymczak1, Jacek Rubik2, Ryszard Grenda2, Piotr Gastoł3, Małgorzata Syczewska1, Piotr Kaliciński1.
1Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland; 2Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland; 3Department of Urology, Children's Memorial Health Institute, Warsaw, Poland
Introduction: Kidney transplantation (KTx) is the best option for patients with end stage kidney disease. The group of special consideration are pediatric patients with bladder dysfunction who constitute about 25-35% of all pediatric recipients of kidney transplant.
Objective: The aim of the study was to analyze the occurrence of urological complications (urinoma, ureteral stenosis, renal calculi,vesicoureteral reflux, ureteral necrosis) and urinary tract infections (UTI) depending on urological solution of urinary outflow (normal bladder vs dysfuncional native bladder vs augmented bladder vs incontinent urinary diversion m.Bricker).
Material and method: Between 2000 and 2020 822 KTx (including 54 reKTx) were performed in our institution. There were 33 Ktx excluded from analysis in patients who were more than 18 years old. Finally 789 KTx were analyzed. Patients were divided into 4 groups: KTx into normal bladder – 538 (group A) , augmented bladder - 12(group B), dysfunctional native bladder – 150 (group C), incontinent urinary diversion m.Bricker- 89 KTx (group D). In these groups the incidence of urological complcations and urinary tract infections were analyzed and compared between groups. Statistical analysis was performed including the graft and patient survival .
Results: The incidence of urological complcations were 9% (group A) vs25% (group B) vs 28,6% (group C) vs 16%(group D). The incidence of urinary tract infections were 20% (group A) vs 83% (group B) vs 56% ( group C) vs 65%(group D). There were not differences in graft and patient survival within analyzed groups.
Conclusions: Kidney transplantation into the dysfunctional bladder is exposed to the risk of increased frequency of urinary tract infections and urological complications however not diminished survival. Kidney transplantation into incontinent urinary diversion m.Bricker is not associated with increased rate of complications and UTI and should be included in the armamentarium of urinary outflow procedures.
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