Long-term Outcome of 1-step Kidney Transplantation and Bladder Augmentation Procedure in Pediatric Patients. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Cleper, Roxana; Ben Meir, David; Krause, Irit; Livne, Pinchas; Mor, Eitan; Davidovits, Miriam; Dagan, Amit
• Is Part Of: Transplantation. Volume 102:Issue 6(2018)
• Publication Date: 2018-06
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000002050
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Guidelines for bladder augmentation (BA) in kidney transplantation (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure. Methods: A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA. Results: Compared with 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate, 96.5 ± 17.1 versus 79.4 ± 16.6 mL/min at 0 to 6 months ( P = 0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) versus 13% (3/22); and asymptomatic bacteriuria was more common: 100% versus 9% during the first 6 months ( P < 0.001), 55% versus 9% ( P = 0.02) and 66.6% versus 9% during the first and second years, respectively ( P = 0.004). Urinary tract infection (UTI) incidence was also higher: 100% versus 23% during the first 6 months and 44% versus 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: estimated glomerular filtration rate was 47.7 ± 39.7 mL/min versus 69 ± 21.3 mL/min, with only 6 (66%) of 9 functioning grafts versus 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTIs in 2 patients. Conclusions: Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy. Abstract : Simultaneous bladder augmentation (BA) with kidney transplantation (KT) shows poorer short-term outcome than KT only patients due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy, including clean intermittent catheterization in BA-KT patients.