PediatricsImpact of vesicoureteral reflux on graft survival in paediatric kidney transplants
Section snippets
Patients and methods
From June 1995 to December 1996 we carried out 146 paediatric renal transplants in 143 patients. Mean age was 13.7 ± 6.5 years; 76 were male and 67 were female. Mean body weight was 34.6 ± 14.6 kg. The kidney was placed extraperitoneally in 144 patients. Great vessels (aorta and cava), common iliac artery and vein, or external iliac artery and vein were used for vascular anastomosis depending on size of recipient. Extravesicular antirefluxive ureteroneocystostomy, according to Lich–Gregoire,
Results
Actuarial patient survival rates at 1 year and 2 years were 96% and 94%, respectively. Actuarial graft survival rates in group A vs group B were 100% and 100% (NS) at 1 year 100% and 100% at 2 years, respectively. Mean calculated creatinine was 1.07 ± 0.27 and 1.13 ± 0.40 (NS) at 1 year in group A and group B, respectively. Mean calculated GFR was 76.84 ± 16.62 and 77.86 ± 16.46 in group A vs group B (NS), respectively. Analysis was extended further by considering the grade of reflux (I to IV).
Discussion
Although the occurrence of more dangerous urologic complications, such as ureteral leaks, necrosis, or obstructions are considered first priority problems, a great deal of interest has also been focused on the avoidance of vesicoureteral reflux after renal transplantation. Curvelier et al6 has provided evidence that UTI did not affect patient survival or graft function and the presence of VUR was not a predisposing factor for UTI. Only in grade IV was a slight decrease of GFR detected, although
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Ureteral stricture after pediatric kidney transplantation: Is there a role for percutaneous antegrade ureteroplasty?
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2012, Journal of Pediatric UrologyCitation Excerpt :VUR is thought to predispose to renal graft damage by facilitating passage of bacteria from the bladder into the transplant graft itself. The focal scarring caused can lead onto reduced renal function and graft dysfunction [6,17,18]. In animal experiments using the piglet model [19], Ransley and Risdon demonstrated that renal papillae from scarred and unscarred kidney segments have different shapes.
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2011, Transplantation ProceedingsAn evaluation of current surgical techniques used for vesicoureteric anastomosis in paediatric renal transplantation in the United Kingdom
2010, British Journal of Medical and Surgical UrologyCitation Excerpt :All these can significantly affect the quality of life of the paediatric renal graft recipient. In addition to the use of anti-reflux surgery other possible techniques that may prevent paediatric renal transplant graft damage include minimizing operative times, avoiding leaks and obstructions of VUR and post transplant UTI's [5,14,15]. Paediatric renal transplants are at high risk of developing segmental pyelonephritic scars if infected urine refluxes into the graft either through a transanastomotic stent or later from vesico-ureteric reflux.
An evaluation of current surgical techniques used for vesicoureteric anastomosis in paediatric renal transplantation in the United Kingdom
2010, Journal of Clinical UrologyCitation Excerpt :All these can significantly affect the quality of life of the paediatric renal graft recipient. In addition to the use of anti-reflux surgery other possible techniques that may prevent paediatric renal transplant graft damage include minimizing operative times, avoiding leaks and obstructions of VUR and post transplant UTI's [5,14,15]. Paediatric renal transplants are at high risk of developing segmental pyelonephritic scars if infected urine refluxes into the graft either through a transanastomotic stent or later from vesico-ureteric reflux.
The Diagnosis and Medical Management of Primary Vesicoureteral Reflux
2010, Pediatric Urology