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Transplanting into a Diverted System: Is it Safe in Children?

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Published:25th Mar 2020
Purpose: Historically surgeons caring for children with urinary diversions for bladder outlet obstruction routinely undiverted the child prior to renal transplant. We review the outcomes of patients undergoing kidney transplantation with and without diversion. We hypothesize that patients transplanted into a diverted system will have outcomes similar to those transplanted into a normal bladder. Materials And Methods: A retrospective cohort study of children receiving renal transplants at our institution from 1993 to 2006 was conducted. Patients whose etiology of end-stage renal disease was either obstructive uropathy (OU) or renal dysplasia (RD) were included. Patients with less than five years of follow-up were excluded from the analysis. Four groups were assembled: Group1) control group of subjects with RD, Group2) OU, not diverted at the time of transplant, Group3) OU, diverted at the time of transplant, and Group4) OU, augmented prior to transplant. The Kruskal-Wallis test was used to compare groups according to the outcomes of frequency of urinary tract infection (UTI), renal graft function, and graft loss. Results: 80 subjects were eligible based on the above diagnostic criteria; 43 had completed five years of follow-up. There was no significant difference between groups based on age (p=0.508), renal function as measured by GFR (p=0.526) or creatinine (p=0.612), or in the frequency of UTIs (p=0.083). Only one patient from the cohort suffered graft loss. Conclusions: Based on frequency of UTI, renal function, and graft loss five years post-transplant, there appears to be no added risk to transplanting a kidney into a diverted system.

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