Search

Objectives To compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and Methods A database of children (

Summary Introduction Causes for end stage renal disease (ESRD) in children can be categorized into urological causes or non-urological causes. We sought to compare the outcomes of urological and non-urological causes of ESRD in children. Methods Patients were divided into two groups: urological causes of ESRD versus non-urological causes of ESRD. All patients and donors had at least 6 months of follow-up. The main outcomes included the effect on complications and renal function. Comparisons were carried out using the chi-square test or the Student t-test. Multivariate logistic regression analysis was used to define the effect of different variables on the outcome of renal transplantation ( Table ). Results Our study included 123 patients, 91 males. The mean age was 9 years and mean follow up was 46 months. Two-thirds of the patients had non-urological causes of ESRD. Overall survival was 100%, and only one patient needed a graft nephrectomy 3 months after the transplant. The mean estimated glomerular filtration rate was 117 mL/min, and did not differ significantly between the two groups (p = 0.13). Multivariable regression showed that female gender (OR 8.7, 95% CI 2.9–26, p = 0 0.0001) was associated with better renal function, while having a urological cause of ESRD (OR 0.28, CI 0.08–0.98, p = 0 0.05) was associated with worse renal function. Non-urological causes of ESRD were significantly less likely to develop complications following renal transplantation (OR 0.28, CI 0.09–0.89, p = 0 0.03). Conclusion Female patients with non-urological causes of ESRD are more likely to have better long-term renal functions, and less liable to develop complications following renal transplant. Table . Multivariable regression model (stepwise method) for prediction of factors that may affect the renal functions and postoperative complications following transplantation. Variable Odds ratio 95% CI p Renal functions Sex 8.7 2.90–26.00 0.0001 Urological causes of ESRD 0.28 0.08–0.98 0.05 Postoperative complications Non-urological causes of ESRD 0.28 0.09–0.89 0.03 Note. Factors included in the univariate analysis: age, sex, weight, cause of ESRD (urological vs. non-urological), pre-emptive transplantation, dialysis prior to transplantation, gender of donor, gender of recipient. CI = confidence interval; ESRD = end-stage renal disease.

INTRODUCTION AND OBJECTIVES: Patients with obstructive uropathy and voiding dysfunction (OUeVD), such as posterior urethral valves, neurogenic bladder dysfunction and vesicoureteral reflux represent 20% to 30% of kidney transplantation (KT) population. Historically, these patients were denied KT due to suboptimal lower urinary tract (LUT) and frequent UTI that may compromise graft survival. A number of series reported acceptable KT outcomes in these patients compared to patients with normal LUT. We aim to evaluate the outcome of KT in pediatric patients with ESRD due to OUeVD compared to patients with ESRD due to medical renal disease (MRD) METHODS: A retrospective review of patients’ records who underwent KT at Cairo University Pediatrics Hospital from January 2007 through January 2014. Outcomes of KT done for ESRD due OUeVD (Group I) were evaluated and compared with outcomes for KT done for ESRD due to MRD (Group II). Multiple perioperative parameters were examined including ancillary procedures performed to optimize the UT for KT in addition to graft survival. RESULTS: 103 patients underwent KT in the reviewed period with 74/103 (71.8%) males and 29/103 (28.2%) females. Mean patient age at KT was 5.05 12.4 (2.2e18) years. Group I patients included 29 patients while Group II included 74 patients. All patients in Group I needed ancillary procedure prior to KT with 55.2% in Group II. Mean follow up was 3.34 1.63 (1e7) years and 2.12 1.08 (1e5) years for Group I and II, respectively. Mean creatinine at 12 months was 0.94 0.24mg/dL and 0.97 0.36mg/dL for Group I and II respectively, with no statistically significant difference between the 2 groups (p1⁄40.8). All Group I patients were maintaned on TMPeSMX antibiotic prophylaxis. There was no signifant difference in posteKT UTI rates (7/29 (24%) in Group I and 9/74 (12.3%) in Group II (p1⁄40.05). The incidence of backepressure was comparable in both groups, 6/29 (20.69%) in Group I and 16/74 (21.62%) in Group II (P value1⁄40.92). CONCLUSIONS: KT can be safely performed in pediatric patients with OUeVD with/without reconstructed LUT, with results comparable to patients with ESRD due to MRD. Antibiotic prophylaxis helps maintain acceptable UTI rates.