nach oben

Erschienen in:

01.08.2015 | Original Article

Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?

verfasst von: Giulia Ghirardo, Paola Midrio, Pietro Zucchetta, PierGiorgio Gamba, GiovanniFranco Zanon, Luisa Murer, Marco Castagnetti

Erschienen in: Pediatric Nephrology | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

We reviewed our experience with renal transplantation (RTx) in children weighing <15 kg to determine if the presence of lower urinary tract dysfunction (LUTD) influenced the outcome.

Methods

Between 1987 and 2012, 68 RTx were performed in patients weighing less than 15 kg, including 17 with associated LUTD and 51 without. We detailed the lower urinary tract management in these patients, and compared graft survival rates and estimated clearance 12 and 60 months after RTx between groups.

Results

None of the patients without LUTD required any lower urinary tract surgery vs 8 out of 17 (47 %) with LUTD (p = 0.0001). The latter included a temporary incontinent urinary diversion in 5 cases (29 %), namely 2 vesicostomies and 3 cutaneous ureterostomies. After comparable follow-ups, there was no difference in patient survival, graft survival, and glomerular filtration rates between groups.

Conclusions

Provided that there is appropriate bladder management, a concomitant LUTD does not adversely influence the outcome of RTx in patients weighing less than 15 kg. However, 50 % of our patients required lower urinary tract reconstruction and, in 30 %, a temporary incontinent urinary diversion was placed at RTx, since lower urinary tract function could not be assessed reliably, the patient was not collaborative enough to be involved in a voiding program, and/or the RTx was prioritized.

Benfield MR, McDonald RA, Bartosh S, Ho PL, Harmon W (2003) Changing trends in pediatric transplantation: 2001 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 7:321–335PubMedCrossRef

Millan MT, Sarwal MM, Lemley KV, Yorgin P, Orlandi P, So S, Alexander S, Salvatierra O Jr (2000) A 100 % 2-year graft survival can be attained in high-risk 15-kg or smaller infant recipients of kidney allografts. Arch Surg 135:1063–1068PubMedCrossRef

Mickelson JJ, MacNeily AE, Leblanc J, White C, Gourlay WA (2006) Renal transplantation in children 15 Kg or less: the British Columbia Children’s Hospital experience. J Urol 176:1797–1800PubMedCrossRef

Morita K, Iwami D, Hotta K, Shimoda N, Miura M, Watarai Y, Hoshii S, Obikane K, Nakashima T, Sasaki S, Nonomura K (2009) Pediatric kidney transplantation is safe and available for patients with urological anomalies as well as those with primary renal diseases. Pediatr Transplant 13:200–205PubMedCrossRef

Nahas WC, Antonopoulos IM, Piovesan AC, Pereira LM, Kanashiro H, David-Neto E, Ianhez LE, Srougi M (2008) Comparison of renal transplantation outcomes in children with and without bladder dysfunction. A customized approach equals the difference. J Urol 179:712–716PubMedCrossRef

Taghizadeh AK, Desai D, Ledermann SE, Shroff R, Marks SD, Koffman G, Duffy PG, Cuckow PM (2007) Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children. BJU Int 100:1365–1370PubMedCrossRef

DeFoor W, Minevich E, McEnery P, Tackett L, Reeves D, Sheldon C (2003) Lower urinary tract reconstruction is safe and effective in children with end stage renal disease. J Urol 170:1497–1500PubMedCrossRef

Guerra L, Leonard M, Castagnetti M (2014) Best practice in the assessment of bladder function in infants. Ther Adv Urol 6:148–164PubMedCentralPubMedCrossRef

Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843PubMedCrossRef

10.

Castagnetti M, Zhapa E, Berrettini A, Ghirardo G, Murer L, Zanon GF, Rigamonti W (2010) Lower urinary tract symptoms (LUTS) after renal transplant in non-urologic anuric patients. Pediatr Transplant 14:859–862PubMedCrossRef

11.

Singer JS, Zaid U, Gritsch HA, Lerman SE, Churchill BM (2009) Selective use of voiding cystourethrography in children undergoing renal transplant evaluation. J Urol 182:1158–1162PubMedCrossRef

12.

Castagnetti M, Angelini L, Ghirardo G, Zucchetta P, Gamba P, Zanon G, Murer L, Rigamonti W (2014) Ureteral complications after renal transplant in children: timing of presentation, and their open and endoscopic management. Pediatr Transplant 18:150–154PubMedCrossRef

13.

Ruiz E, Cateriano JE, Lobos P, de Badiola FI, Boer M, Moldes J, Puigdevall J, Ferraris J (2006) Kidney transplantation in small children with live related donors: 20 years of experience. J Pediatr Urol 2:373–379PubMedCrossRef

14.

Elsheemy MS, Shouman AM, Shoukry AI, Soaida S, Salah DM, Yousef AM, Morsi HA, Fadel FI, Sadek SZ (2014) Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less. J Pediatr Urol 10:737–743PubMedCrossRef

Titel: Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?
verfasst von: Giulia Ghirardo
Paola Midrio
Pietro Zucchetta
PierGiorgio Gamba
GiovanniFranco Zanon
Luisa Murer
Marco Castagnetti
Publikationsdatum: 01.08.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 8/2015
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-015-3047-0

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?