Long-term outcome of one-step kidney transplantation and bladder augmentation procedure in pediatric patients
Guidelines for bladder augmentation (BA) in kidney transplant (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure.Methods
A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA.Results
Compared to 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate (eGFR): 96.5±17.1 vs. 79.4±16.6 ml/min at 0-6 months (p=0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) vs. 13% (3/22); and asymptomatic bacteriuria was more common: 100% vs. 9% during the first 6 months (P<0.001), 55% vs 9% (p=0.02) and 66.6% vs 9% during the first and second years, respectively (p=0.004). Urinary tract infection (UTI) incidence was also higher: 100% vs. 23% during the first 6 months and 44% vs 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: eGFR was 47.7±39.7 ml/min vs 69±21.3ml/min, with only 6/9 (66%) functioning grafts vs. 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTIs in 2.Conclusions
Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy.