Renal transplantation in reconstructed bladders: lessons learned from a 5 year experience with 33 patients

PurposeThe aim of this study was to review our experience with renal transplantation in children with bladder augmentation.Material and methodsBetween Jan 2001 and May 2006, 287 renal transplants were performed in children and adolescents at the Hospital do Rim e Hipertensão (Kidney and Hypertension Hospital) / UNIFESP. Thirty three patients (12%) had previously undergone reconstruction of the lower urinary tract.ResultsThe mean follow up was 24 months. Patient's mean age was 11 years old (1-17 years old). Living related donor grafts were performed in 11 patients (33.3%) and 22 (66.6%) patients received cadaveric donor grafts. The etiologies of the bladder dysfunction were posterior urethral valves in 18 patients, neurogenic bladder in 12, vesicoureteral reflux in 2, other bladder malformations in 1. Ileocystoplasty or sigmoidcystoplasty were performed in 29 patients. In four patients a ureterocystoplasty was created. All patients had the augmentation prior to the renal transplant. The interval between the bladder augmentations and the transplantation ranged from 2 to 108 months (mean 31 months). Of the 33 patients with an augmentation 3 (10%) perform CIC through the urethra. In 20 patients abdominal urinary stomas (Mitrofanoff or Macedo) were created and all these patients perform CIC through these stomas. Only 10 patients voided spontaneously. The mean creatinine level at the first 6 months post transplantation was 1.1 +/- 0.3 mg/dl and by 12 months, 1.0+/- 0.2 mg/dl. The incidence of UTI at the first 12 months was 83%. The graft survival rate was 91% at 1 year follow-up.ConclusionsPediatric patients who underwent lower urinary tract reconstructution prior to renal transplantation present a high incidence of UTI's in the first pos-transplant year. Nevertheless the graft survival is similar to the reported data in the literature without previous bladder reconstruction.