Nephrol Dial Transplant (2000) 15: 1852-1858
© 2000 European Renal Association-European Dialysis and Transplant Association
Vesicoureteral reflux after kidney transplantation in children
1 Département de Pédiatrie, hôpital Edouard Herriot, 2 Centre d'Information Médicale, Hôtel-Dieu, 3 Service d'Urologie et Chirurgie de la Transplantation, 4 Service de Radiologie Pédiatrique, 5 Service d'Exploration Fonctionnelle Rénale, 6 Service de Réanimation Pédiatrique, hôpital Edouard Herriot, Université Claude Bernard, Lyon, France
Background. The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation in adults varies between authors and there have been few reports in children.
Methods. We conducted a retrospective study in a single-centre paediatric cohort. Fifty-five of the 84 children who underwent kidney transplantation over a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation.
Results. VUR into the graft was present in 58% of the patients. Graft function and incidence of urinary-tract infections were similar in the two groups, independent of VUR. After having excluded infections attributed to the presence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with VUR (P=0.017 and P=0.0039 respectively). None of the eight patients with VUR treated with antibiotic prophylaxis after a first acute pyelonephritis (APN) episode presented subsequent APN after 4.4±3.3 years on therapy.
Conclusions. VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.
Keywords: child; kidney transplantation; renal function; urinary-tract infection; vesicoureteral reflux
Correspondence and offprint requests to: Pierre Cochat, Département de Pédiatrie, hôpital Edouard Herriot, F-69437 Lyon cedex 03, France.
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