Nephrology Dialysis Transplantation, Vol 13, Issue 8 2065-2069, Copyright © 1998 by Oxford University Press
A Crowe, H Cairns, S Wood, C Rudge, C Woodhouse and G Neild
Background. Renal allograft outcome, during an 8 year
period (1985-1992), has been assessed in 56 renal transplants performed in
55 patients who had end-stage renal failure as a consequence of urological
abnormalities. The abnormalities were: primary vesicoureteric reflux (VUR)
or renal dysplasia (26 patients); posterior urethral valves (PUV) (15);
neuropathic bladders (6); vesico-ureteric tuberculosis (5); bladder
exstrophy (3); and prune belly syndrome (1). Six patients had augmented
bladders, and eight transplants were performed in seven patients with
urinary diversions. Results. Overall, 1 and 5 year
actuarial graft survival was 89 and 66%, with mean creatinine of 154
&mgr;mol/l ± 11 (SE) and 145 ± 9 respectively.
Patients with abnormal bladders or conduits (n = 28)
had worse graft function than those with normal bladders
(n = 28) although graft survival was not significantly
different in the two groups at 1 and 5 years: 93 and 75% with normal
bladders vs 86 and 57% with abnormal systems.
Symptomatic urinary tract infections were common in the first 3 months
after transplantation (63%); fever and systemic symptoms occurred in 39%
with normal bladders and 59% with abnormal bladders. Urinary tract
infection directly contributed to graft loss in six patients with abnormal
bladders, but had no consequences in those with normal bladders.
Conclusions. Abnormal bladders must be assessed
urodynamically before transplantation, and after transplantation adequacy
of urinary drainage must be re-assessed frequently. Prophylactic antibodies
are now given for the first 6 months and urinary tract infections must be
treated promptly. With these measures, good results, similar to those of
patients without urological problems, can be obtained.
Keywords: Abnormal bladder; enterocystoplasty; renal
transplantation; urinary diversion
ORIGINAL ARTICLES
Renal transplantation following renal failure due to urological disorders
Institute of Urology and Nephrology, University College and Middlesex School of Medicine, Middlesex Hospital, London, UK; Correspondence to: GH Neild, Department of Nephrology, Middlesex Hospital, Mortimer Street, London W1N 8AA, UK
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