32nd ESPU Congress in Ghent, Belgium

S20: RENAL TRANSPLANTATION

Moderators: Sadaf Aba Umer (Pakistan), Anna Bujons (Spain)

ESPU Meeting on Saturday 11, June 2022, 09:45 - 10:15


09:45 - 09:48
S20-1 (OP)

INCIDENCE AND IMPACT OF POST-TRANSPLANT VESICOURETERAL REFLUX IN PEDIATRIC AGE GROUP: SINGLE CENTER EXPERIENCE

Osama SARHAN 1, Abdulmohsin AL FADDAGH 2, Abdelrahman AL SULTAN 2, Ahmed ALSHAMMARI 2, Helmy OMAR 2 and Fouad AL KAWAI 2
1) Mansoura Urology and Nephrology Center, Urology, Mansoura, EGYPT - 2) King Fahad Specialist Hospital, Urology, Dammam, SAUDI ARABIA

PURPOSE

Vesicoureteral reflux (VUR) occurs up to 50% after pediatric renal transplantation and its impact on graft outcome is still debatable. We reviewed our pediatric renal transplant experience to determine the incidence and the impact of post-transplant VUR on the future graft function.

MATERIAL AND METHODS

We retrospectively evaluated all children who underwent renal transplantation at our institution between 2008 and 2020. All medical records were inspected to obtain baseline demographics, etiology of ESRD, age at transplant, type of transplant, operative details, post-operative complications, clinical laboratory and radiological condition at last follow-up.

RESULTS

A total of 149 children (92 males and 57 females) with a median age at transplant of 8 years (range 2-18 years) were included. Of those patients, 93 patients (62%) received a living donor transplant while the remaining 56 (38%) received a deceased donor kidney. A VCUG was carried out in 88 patients (59%) post-renal transplant due to recurrent UTIs or persistent graft hydronephrosis and VUR was evident in 46 patients. Post-renal transplant UTIs developed in 53 cases (35%) and there was no significant difference between cases with VUR and without VUR (p=0.15). In all patients with a proved VUR, a prophylactic antibiotics were initiated for 3-6 months. The majority of cases responded favorably to the antibioprophylaxis while anti-reflux management was necessitated in 11 patients (9 Deflux injection, 3 uretero-vesical reimplantation). After a median follow-up period of 5 years, chronic kidney disease (CKD) developed in 31 cases (21%) and it was significantly associated with the presence of post-transplant VUR (p=0.03).

CONCLUSIONS

There was a high incidence of post-transplant VUR in pediatric age group even though antireflux technique was used. Most of cases could be managed conservatively and only few cases needed surgical anti-reflux intervention. Association of VUR and poor graft function was evident in our cohort of patients.


09:48 - 09:51
S20-2 (OP)

QUANTIFYING THE RISK AND EFFECT OF URINARY TRACT INFECTION FOLLOWING PAEDIATRIC RENAL TRANSPLANTATION

Raef JACKSON 1, Sinan ALWAN 1, Andrew ROBB 1, Khalid SHARIF 2, Evelyn ONG 3, Ram BALASUBRAMANIAN 4, Mordi MUORAH 4 and Liam Sean Lloyd MCCARTHY 5
1) Birmingham Children's Hospital, Paediatric Urology, Birmingham, UNITED KINGDOM - 2) Birmingham Children's Hospital, Transplantation, Birmingham, UNITED KINGDOM - 3) Birmingham Children's Hospital, Liver and Transplantation, Birmingham, UNITED KINGDOM - 4) Birmingham Children's Hospital, Paediatric Nephrology, Birmingham, UNITED KINGDOM - 5) Birmingham Children's Hospital, Department of Urology, Birmingham, UNITED KINGDOM

PURPOSE

Risk of Urinary tract infections (UTIs) increase post renal transplant and increase graft loss.

We aimed to quantify this risk by comparing UTIs pre and post renal transplantation , performing sub-group analysis comparing urological (A) to primary renal causes (B), and correlating renal function progression with this.

MATERIAL AND METHODS

Retrospective data was obtained: underlying diagnosis, age at transplant, date of transplant, dates of culture proven UTIs with pure growths and significant pyuria pre and post-transplant, nadir creatinine and most recent creatinine post-transplantation. Rate of UTIs were calculated as UTIs/month.

This was registered with our hospital audit unit.

Analysis of rate (median and IQR), numbers (%) were performed using Wilcoxon paired test, Fisher Exact tests and Spearman correlation, P<0.05 taken as significant.

RESULTS

58 Patients were identified. 19 had urological causes for End stage renal failure (ESRF), 39 were renal. Age at transplant 11(6-13) years, follow-up 44(30-72)months.

Pre-transplant 0.00(0.00-0.095) UTIs/month were found vs 0.34(0.00-0.68), P<0.0001. 31% had UTIs pre transplant, increasing to 69% post transplantation, P<0.0001. Sub-group analysis showed (A) had 11/19(58%) UTIs, vs 17/19(89%), P=0.0625; whereas in (B) 7/39(18%) had UTIs pre vs 23/39(59%) post-transplant, P=0.0004. The rate of UTIs pre and post-transplant increased significantly for both groups: (A) 0.01(0.00-0.28) vs. 0.43(0.31-0.61), P=0.001; (B) 0(0-0) vs 0.13(0.00-0.77), P<0.0001.

Graft deterioration as measure by rate of creatinine rise (µmols/l/month) correlated with number of UTIs, r=0.267, P=0.04.

CONCLUSIONS

Renal transplantation in children is associated with a marked increased risk of UTI (69%), those with an underlying urological abnormality are especially at risk (89%). Approximately 10% graft deterioration was associated with recurrent UTIs.


09:51 - 09:54
S20-3 (OP)

EVOLUTION OF BLADDER FUNCTION IN CHILDREN WITH POSTERIOR URETHRAL VALVES AFTER RENAL TRANSPLANTION

Annabel PAYE-JAOUEN 1, Nathalie BOTTO 1, Nardjess MESLEM 1, Lucile MARSAC 2, Liza ALI 1, Jérôme NAUDIN 3, Veronique BAUDOUIN 4, Theresa KWON 4, Pauline LOPEZ 1, Lise NATIO 1, Eliane JOSSET-RAFFET 1, Arnaud BONNARD 1, Julien HOGAN 4, Alaa EL GHONEIMI 1 and Matthieu PEYCELON 1
1) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert Debre, APHP, University of Paris, Paris, FRANCE - 2) Department of pediatric anesthesiology, University Hospital Robert Debre, APHP, P, FRANCE - 3) Department of pediatric intensive care unit, University Hospital Robert Debre, APHP, Paris, FRANCE - 4) Department of pediatric nephrology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert Debre, APHP, University of Paris, Paris, FRANCE

PURPOSE

Renal transplantation (RT) in children with posterior urethral valves (PUV) is challenging. No studies have yet been carried out on the beneficial effect of RT on the evolution of bladder function. Our objective was to study the longitudinal evolution of bladder function in children with PUV, before and after RT.

MATERIAL AND METHODS

Children born with PUV and transplanted between 1989 and 2021 were retrospectively identified. Exclusion criteria (N=3): short-term graft loss, bladder augmentation, cutaneous ureteroenteric anastomosis. Patients were divided into three groups according to bladder function evaluated by urodynamic studies before RT: group 1 (N=6), no bladder dysfunction; group 2 (N=10), patients who required only medications (anticholinergics, alpha-blockers) for hypocontractile and enlarged bladder (N=4), or hyperactive bladder with normal compliance (N=4), or hypocompliant bladder (N=2), and group 3 (N=10), patients with valve bladder syndrome on CIC. Primary outcome was evolution of bladder function according to urodynamics after RT. Statistics: univariate analysis (Mann-Whitney, Fisher's, Chi2, and ANOVA).

RESULTS

A total of 29 children born with PUV was transplanted at a median (IQR) age of 9.4 (3-15) years and followed up for 11.6 years (2-27). Five and 10-year graft survival rate were 92 and 73%, respectively. Bladder function after RT improved in 19 children (73%) (p=0.06): 8 children on 10 in group 2 did not require any medication anymore (p=0.01); 5 on 10 in group 3 were instructed to stop CIC (p=0.03). Despite RT, 3 patients  presented valve bladder syndrome and still required anticholinergics, alpha-blockers, and CIC.

CONCLUSIONS

Bladder function improved after renal transplantation in children born with PUV, even with patients who presented valve bladder syndrome. Successful outcomes are associated with regular urological follow-up and urodynamics evaluation.


09:54 - 09:57
S20-4 (OP)

DONOR-RECIPIENT SIZE MISMATCH IN KIDNEY TRANSPLANTATION OF CHILDREN WEIGHING ≤15 KG

Rosa M ROMERO 1, Julia FIJO 2, Ana SANCHEZ MORENO 2, Sebastian ROLDAN 3, Eduardo LEON 4, Rafael MEDINA 4, Francisco DE LA CERDA 2, Edith HERNANDEZ CALVARRO 3 and Rocio VIZCAINO 3
1) Hospital Universitario Virgen del Rocio, Paediatric Urology, Seville, SPAIN - 2) Hospital Universitario Virgen del Rocio, Pediatric Nephrology, Seville, SPAIN - 3) Hospital Universitario Virgen del Rocio, Pediatric Urology, Seville, SPAIN - 4) Hospital Universitario Virgen del Rocío, Urology, Sevlle, SPAIN

PURPOSE

Kidney transplantation is the treatment choice in children with ESRD. There is no consensus on minimum weight and/or age limit, and the impact of donor receptor weight mismatch is unclear.

We aim to study the effect of donor-receptor size mismatch (DRSM) in kidney transplantation in small children.

MATERIAL AND METHODS

We include patients weighing ≤15 KG receiving a kidney transplant from 2005 to 2021. Data from our prospective institutional database was included in the study. We analyze demographics, donor (age, weight, height, living donor (LD), deceased donor(DD)), postoperative and long-term outcomes. Comparative analysis according to DRSM and graft type (adult ASK/pediatric or matched MSK).

RESULTS

Thirty-three children with a mean weight 12,9 ± 1,67 (9-15)kg. Thirteen received a MSK (mean weight 19,7±4,3 (11-27) kg), and 20 patients had ASK (57,3± 12,7 (33-79) kg (LD 10/DD 10)
DRSM was 4,38±1,1 (2,2-6,3) for ASK and 1,62 ± 0,37 (1,13-2.25) for SMK, with no differences in recipient weight among both groups.
There were no graft losses with a 100% graft survival in the first year. Graft survival was 89% at 5 years follow up and 80% at 10 years, with better survival in patients receiving a MSK and a LD graft.
Postoperative outcome demonstrated increased need of inotropic, transfusion, length of intensive care stay, and overall hospitalization with higher DRSM.

CONCLUSIONS

Kidney transplant in small children has excellent short-term and long-term outcomes.
Higher DRSM is associated with increased postoperative morbidity; this does not affect long term outcomes. Outcome is superior in MSK and LD.


09:57 - 10:15
Discussion