Eur J Pediatr Surg 2010; 20(1): 5-10
DOI: 10.1055/s-0029-1234114
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Kidney Transplantation in Children with Bladder Augmentation or Ileal Conduit Diversion

D. Broniszczak1 , H. Ismail1 , P. Nachulewicz1 , M. Szymczak1 , T. Drewniak1 , M. Markiewicz-Kijewska1 , A. Kowalski1 , K. Jobs1 , E. Śmirska2 , J. Rubik2 , L. Skobejko-Włodarska3 , P. Gastoł3 , A. Mikołajczyk3 , P. Kalicinski1
  • 1Children's Memorial Health Institute, Department of Pediatric Surgery and Organ Transplantation, Warsaw, Poland
  • 2Children's Memorial Health Institute, Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Warsaw, Poland
  • 3Children's Memorial Health Institute, Department of Urology, Warsaw, Poland
Further Information

Publication History

received February 17, 2009

accepted after revision July 12, 2009

Publication Date:
28 October 2009 (online)

Abstract

Introduction: Various congenital and acquired diseases of the lower urinary tract can lead to chronic renal failure requiring renal replacement therapy.

Aim: The aim of the study was to assess problems and results of kidney transplantation in children with significant lower urinary tract dysfunction.

Materials and Methods: Between 1984 and 2007, there were 33 kidney transplantations in children with end-stage renal disease and severe lower tract dysfunction out of 539 kidney transplantations performed in our department. The patients were 23 males and 10 females. Thirty patients received a kidney from a deceased donor, the remaining 3 from a living related donor. The age at transplantation ranged from 2.25 years to 19 years. In 26 patients an ileal conduit modo Bricker was created (in 21 patients at transplant operation). Bladder augmentation was performed in 6 patients and a continent urinary reservoir was created in 1.

Results: Post-transplant follow-up ranged from 7 to 88 months (mean 32 months). Overall patient survival is 100% and graft survival is 97%. Creatinine concentrations ranged from 0.3 to 3.4 mg% (mean 0.92 mg%). Surgical complications were diagnosed in 16 patients. All surgical complications were treated successfully and none of them caused graft loss. Urinary tract infections (UTI) were the most commonly observed complication, occurring in 26/33 (78%) patients, but the majority of these UTI were asymptomatic and had no influence on graft function.

Conclusions: Kidney transplantation in children with lower urinary tract dysfunction and end-stage renal failure offers excellent medium term results in our experience, despite the creation of non-standard urinary drainage. Recurrent urinary tract infections are the most common complications in these patients, but in the majority of cases this does not lead to impairment of graft function.

References

  • 1 Adams J, Mehls O, Wiesel M. Pediatric renal transplantation and the dysfunctional bladder.  Transpl Int. 2004;  17 596-602
  • 2 Barry JM. Kidney transplantation into patients with abnormal bladders.  Transplantation. 2004;  77 1120-1123
  • 3 Capizzi A, Zanon GF, Zacchello G. et al . Kidney transplantation in children with reconstructed bladder.  Transplantation. 2004;  77 1113-1116
  • 4 Coosemans W, Baert L, Kuypers D. et al . Renal transplantation onto abnormal urinary tract: ileal conduit urinary diversion.  Transplant Proc. 2001;  33 2493-2494
  • 5 Crowe A, Cairns HS, Wood S. et al . Renal transplantation following renal failure due to urological disorders.  Nephrol Dial Transplant. 1998;  13 2065-2069
  • 6 Fontaine E, Gagnadoux MF, Niaudet P. et al . Renal transplantation in children with augmentation cystoplasty: long-term results.  J Urol. 1998;  159 2110-2113
  • 7 Franc-Guimond J, González R. Renal transplantation in children with reconstructed bladders.  Transplantation. 2004;  77 1116-1120
  • 8 Hatch DA, Belitsky P, Barry JM. et al . Fate of renal allografts transplanted in patients with urinary diversion.  Transplantation. 1993;  56 838-842
  • 9 Hatch DA, Koyle MA, Baskin LS. et al . Kidney transplantation in children with urinary diversion or bladder augmentation.  J Urol. 2001;  165 2265-2268
  • 10 Herthelius M, Oborn H. Urinary tract infections and bladder dysfunction after renal transplantation in children.  J Urol. 2007;  177 1883-1886
  • 11 Husmann DA, Rathbun SR. Long-term follow up of enteric bladder augmentations: The risk for malignancy.  J Pediatr Urol. 2008;  4 381-385
  • 12 Koo HP, Bunchman TE, Flynn JT. et al . Renal transplantation in children with severe lower urinary tract dysfunction.  J Urol. 1999;  161 240-245
  • 13 Lawrenson R, Wyndaele JJ, Vlachonikolis I. et al . Renal failure in patients with neurogenic lower urinary tract dysfunction.  Neuroepidemiology. 2001;  20 138-143
  • 14 Luke PP, Herz DB, Bellinger MF. et al . Long-term results of pediatric renal transplantation into a dysfunctional lower urinary tract.  Transplantation. 2003;  76 1578-1582
  • 15 Mendizábal S, Estornell F, Zamora I. et al . Renal transplantation in children with severe bladder dysfunction.  J Urol. 2005;  173 226-229
  • 16 Nahas WC, Mazzucchi E, Arap MA. et al . How to deal with children with end-stage renal disease and severe bladder dysfunction.  Transplant Proc. 2003;  35 849-850
  • 17 Nahas WC, Lucon M, Mazzucchi E. et al . Clinical and urodynamic evaluation after ureterocystoplasty and kidney transplantation.  J Urol. 2004;  171 1428-1431
  • 18 Neild GH, Dakmish A, Wood S. et al . Renal transplantation in adults with abnormal bladders.  Transplantation. 2004;  77 1123-1127
  • 19 Nguyen DH, Reinberg Y, Gonzalez R. et al . Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study.  J Urol. 1990;  144 1349-1351
  • 20 Palmer LS, Franco I, Kogan SJ. et al . Urolithiasis in children following augmentation cystoplasty.  J Urol. 1993;  150 726-729
  • 21 Power RE, O’Malley KJ, Little DM. et al . Long-term follow up of cadaveric renal transplantation in patients with spina bifida.  J Urol. 2002;  167 477-479
  • 22 Rigamonti W, Capizzi A, Zacchello G. et al . Kidney transplantation into bladder augmentation or urinary diversion: long-term results.  Transplantation. 2005;  80 1435-1440
  • 23 Rischmann P, Malavaud B, Bitker MO. et al . Results of 51 renal transplants with the use of bowel conduits in patients with impaired bladder function: a retrospective multicenter study.  Transplant Proc. 1995;  27 2427-2429
  • 24 Stein R, Fisch M, Ermert A. et al . Urinary diversion and orthotopic bladder substitution in children and young adults with neurogenic bladder: a safe option for treatment?.  J Urol. 2000;  163 568-573
  • 25 Sullivan ME, Reynard JM, Cranston DW. Renal transplantation into the abnormal lower urinary tract.  BJU Int. 2003;  92 510-515
  • 26 Surange RS, Johnson RW, Tavakoli A. et al . Kidney transplantation into an ileal conduit: a single center experience of 59 cases.  J Urol. 2003;  170 1727-1730
  • 27 Toda F, Tanabe K, Ishikawa N. et al . Renal transplantation in patients with lower urinary tract dysfunction.  Transplant Proc. 1998;  30 3007-3009
  • 28 Warholm C, Berglund J, Andersson J. et al . Renal transplantation in patients with urinary diversion: a case-control study.  Nephrol Dial Transplant. 1999;  14 2937-2940

Correspondence

Dr. Dorota Broniszczak

Children's Memorial Health Institute

Pediatric Surgery and Organ Transplantation

Al. Dzieci Polskich 20

04-730 Warsaw

Poland

Phone: +48 22 815 13 60

Fax: +48 22 815 14 50

Email: dorbro1@poczta.onet.pl