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Nephrol Dial Transplant (1999) 14: 2937-2940
© 1999 European Renal Association-European Dialysis and Transplant Association

Renal transplantation in patients with urinary diversion: a case-control study

Carl Warholm1,2, Jonas Berglund2, Jan Andersson3 and Gunnar Tydén1

1 Departments of Transplantation Surgery, Karolinska Institute at Huddinge Hospital, 2 Nephrology, Karolinska Institute at Karolinska and Danderyd Hospitals and 3 Infectious Diseases, Karolinska Institute at Huddinge Hospital, Sweden

Correspondence and offprint requests to: Carl Warholm, Karolinska Institute, Danderyd Hospital, S-182 88 Danderyd, Sweden.

Background. Renal transplantation in Sweden in patients with ileal conduits or continent reservoirs was investigated in order to compare the outcome with regard to graft and patient survival as compared to controls.

Methods. Patient data from the four transplantation centres in Sweden were collected on: treatment prior to transplantation, time needed for the operative procedure, and postoperative care and outcome in terms of renal function as well as graft and patient survival at 1 and 5 years. The pattern of urinary tract infection was also investigated. Each case with urinary diversion was matched with two non-diabetic controls.

Results. Ten male and 12 female cases were found who had received 27 grafts between 1982 and 1996. Five patients had a Kock reservoir and 17 had a Bricker conduit. The time needed for the transplant procedure was significantly longer in the case group. After matching the case group with 54 controls, we found that the renal function was similar in both groups. Graft and patient survival was similar in both groups, over 90% after 1 year. Graft survival was about 70% after 5 years. Postoperative surgical complications in the case group were only seen in a few cases. The pattern of bacteria causing urinary tract infection was slightly different among the patients with ileal conduits or continent reservoirs.

Conclusion. Patients with ileal conduits or continent reservoirs have similar graft and patient survival rates as the general kidney transplant population. The presence of constant bacteriuria did not adversely affect survival. Prophylactic antibiotic treatment seems not to be warranted. There appears to be no indication for native nephrectomy, except in selected cases. The study did not show any advantage with regard to continent reservoirs vs ileal conduits.

Keywords: Bricker; human; Kock; renal transplantation; survival; urinary diversion; urinary tract infection


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