Kidney transplantation in children with severe lower urinary tract dysfunction
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Hor Ismail1, Dorota Broniszczak1, Piotr Kaliciński, Paweł Nachulewicz, Marek Szymczak, Tomasz Drewniak, Małgorzata Markiewicz-Kijewska, Adam Kowalski, Katarzyna Jobs, Ewa Mirska, Jacek Rubik, Piotr Gastoł, Lidia Skobejko-Włodarska, A. Mikołajczyk

Klinika Chirurgii Dziecięcej i Transplantacji Narządów, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
Klinika Nefrologii, Transplantacji Nerek i Nadciśnienia Tętniczego, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
Klinika Urologii Dziecięcej, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie

summary

Introduction.

Congenital and acquired diseases of the lower urinary tract can lead to renal impairment requiring kidney transplantation.

Objectives.

The aim of the study was to assess results of kidney transplantation in children with significant lower urinary tract dysfunction performed in our institution.

Materials and methods.

Between 2001 and 2007 there were performed 33 kidney transplantations in children with end stage renal disease and severe lower tract dysfunction in our department. There were 23 males and 10 females. Thirty patients received kidney from deceased donors. Remaining 3 patients received graft from living related donors. The age at transplantation ranged from 2.25 to 19 years. In 26 patients ileal conduit modo Bricker was created (in 21 patients at KTx). Bladder augmentation was performed in 6 patients (ureterocystoplasty – 2, colocystoplasty – 1, ileocystoplasty – 3). Continent urinary reservoir was created in 1 patient.

Results.

Follow-up is from 3 to 84 months (mean 28 months). Overall patient and graft survival is 100%. Creatinine concentration ranges from 0.3 to 5.3 mg% (mean 1.03 mg%). Early postoperative complications included urinary leakage from ureteroileal anastomosis in 2 cases, bleeding in 1, kidney rupture in 2, graft compression in 2, bending of renal artery in 2, renal vein thrombosis in 1. Late complications included vesicoureteral reflux to transplanted kidney in 1, limphocoele in 2, stricture of urostomy in 1, torsion of ileal conduit in 1, bending of ureter in 1 and small bowel obstruction in 1. All surgical complications were treated successfully and were not the cause of graft loss. Urinary tract infections were diagnosed in 25/33 (75%) patients, but in majority of patients UTI were asymptomatic and without impairment of graft function.

Conclusions.

1. Kidney transplantation in children with lower urinary tract dysfunction and end-stage renal failure gives excellent medium range results in our experience despite non-standard urinary drainage into augmented bladder or ileal conduit. 2. Recurrent urinary tract infections are most common complications in these patients, but in majority of patients do not lead to impairment of graft function.