Transplantation in Children with End Stage Renal Disease of Urologic Origin

No AccessJournal of UrologyPediatric Articles1 Oct 1980Transplantation in Children with End Stage Renal Disease of Urologic Origin John N. Krieger, William T. Stubenbord, and E. Darracott Vaughan John N. KriegerJohn N. Krieger Current address: Box 495, Department of Urology, University of Virginia, Charlottesville, Virginia 22908. More articles by this author , William T. StubenbordWilliam T. Stubenbord More articles by this author , and E. Darracott VaughanE. Darracott Vaughan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)55515-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Urologic disease is an important cause of end stage renal failure in children. Our experience with more than 700 renal transplants includes 30 children with renal failure of urologic origin who have received 34 renal homografts. The nature and natural history of the primary disease, corrective operations before transplantation, transplantation technique, complications and over-all success rate of these cases are reviewed. Vesicoureteral reflux and posterior urethral valves were the most common causes of end stage renal disease. The average time between diagnosis of a urologic problem and transplantation was 8.1 years. The incidence of renal dysplasia was high. It appears that many patients had limited potential for long-term urologic rehabilitation when they were evaluated initially. A wide variety of genitourinary tract operative procedures were done on 28 patients before transplantation (average 3.3 operations per patient). Cutaneous ureterostomy was the most frequent procedure, often following unsuccessful urologic reconstruction. Ten patients had uncorrectable lower urinary tracts and required construction of intestinal conduits. We recommend that bilateral nephrectomy, correction of lower urinary tract abnormalities or construction of an intestinal conduit, if necessary, be performed before renal transplantation. Transplantation techniques were highly variable. In 16 instances the graft was placed in the iliac fossa. Eighteen grafts were placed intra-abdominally either because of small patient stature or to facilitate use of intestinal conduits. Intra-abdominal graft placement or use of intestinal conduits did not adversely affect allograft success. Complications were frequent and occurred after 30 allografts (88 per cent). Surgical complications occurred after 10 allografts. Most surgical complications were urologic. Infectious complications followed 27 allografts, with urinary tract infection as the most frequent complication. Additional surgical procedures were done at the time of 8 transplants and the incidence of complications was especially high in this group. Over-all, 20 of the 34 renal transplants (59 per cent) were successful, comparing favorably with the success rate in pediatric as well as adult transplantation. We conclude that renal transplantation is the treatment of choice for children with end stage renal disease of urologic origin. © 1980 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByZaragoza M, Ritchey M, Bloom D and McGuire E (2018) Enterocystoplasty in Renal Transplantation Candidates: Urodynamic Evaluation and OutcomeJournal of Urology, VOL. 150, NO. 5 Part 1, (1463-1466), Online publication date: 1-Nov-1993.Groenewegen A, Sukhai R, Nauta J, Scholtmeyer R and Nijman R (2018) Results of Renal Transplantation in Boys Treated for Posterior Urethral ValvesJournal of Urology, VOL. 149, NO. 6, (1517-1520), Online publication date: 1-Jun-1993.Mochon M, Kaiser B, Dunn S, Palmer J, Polinsky M, Schulman S, Flynn J and Baluarte H (2018) Urinary Tract Infections in Children with Posterior Urethral Valves After Kidney TransplantationJournal of Urology, VOL. 148, NO. 6, (1874-1876), Online publication date: 1-Dec-1992.Connor J and Burbige K (2018) Long-Term Urinary Continence and Renal Function in Neonates with Posterior Urethral ValvesJournal of Urology, VOL. 144, NO. 5, (1209-1211), Online publication date: 1-Nov-1990.Nguyen D, Reinberg Y, Gonzalez R, Fryd D and Najarian J (2018) Outcome of Renal Transplantation after Urinary Diversion and Enterocystoplasty: A Retrospective, Controlled StudyJournal of Urology, VOL. 144, NO. 6, (1349-1351), Online publication date: 1-Dec-1990.Krieger J, Boatman E and Kenny G (2018) Ureaplasma Urealyticum Upper Urinary Tract Infection: Persistence and Pathogenicity in a Canine ModelJournal of Urology, VOL. 141, NO. 6, (1437-1443), Online publication date: 1-Jun-1989.Spencer J and Maizels M (2018) Inhibition of Protein Glycosylation Causes Renal Dysplasia in the Chick EmbryoJournal of Urology, VOL. 138, NO. 4 Part 2, (984-990), Online publication date: 1-Oct-1987.MacGregor P, Novick A, Cunningham R, Streem S, Kay R, Steinmuller D, Buszta C and Steinhilber D (2018) Renal Transplantation in End Stage Renal Disease Patients with Existing Urinary DiversionJournal of Urology, VOL. 135, NO. 4, (686-688), Online publication date: 1-Apr-1986.Flechner S, Conley S, Brewer E, Benson G and Corriere J (2018) Intermittent Clean Catheterization: An Alternative to diversion in Continent Transplant Recipients with Lower Urinary Tract DysfunctionJournal of Urology, VOL. 130, NO. 5, (878-881), Online publication date: 1-Nov-1983.Duckett J (2018) Editorial CommentJournal of Urology, VOL. 130, NO. 5, (881-881), Online publication date: 1-Nov-1983.Berman D and Maizels M (2018) The Role of Urinary Obstruction in the Genesis of Renal Dysplasia—A Model in the Chick EmbryoJournal of Urology, VOL. 128, NO. 5, (1091-1096), Online publication date: 1-Nov-1982.Marshall F, Smolev J, Spees E, Jeffs R and Burdick J (2018) The Urological Evaluation and Management of Patients with Congenital Lower Urinary Tract Anomalies Prior to Renal TransplantationJournal of Urology, VOL. 127, NO. 6, (1078-1081), Online publication date: 1-Jun-1982. Volume 124Issue 4October 1980Page: 508-512 Advertisement Copyright & Permissions© 1980 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John N. Krieger Current address: Box 495, Department of Urology, University of Virginia, Charlottesville, Virginia 22908. More articles by this author William T. Stubenbord More articles by this author E. Darracott Vaughan More articles by this author Expand All Advertisement PDF DownloadLoading ...