Abstract
Not many years ago, children with congenital abnormalities of the lower urinary tract or with bladder dysfunction were denied renal transplantation because they were considered very high-risk recipients. However, in the past few decades, we learned that in children with poorly compliant, low-capacity bladders, augmentation cystoplasty (AC) can create a compliant, low-pressure reservoir that helps preserve the kidney graft. Although the incidence of symptomatic urinary tract infection (UTI) may be greater in pediatric transplant recipients with an AC than in those without, UTI is related more to noncompliance with clean intermittent catheterization or vesicoureteral reflux to the native kidney or graft than to the AC itself, and usually does not lead to impairment of graft function. Today, children with a bladder reconstruction may undergo transplantation with the same outcome (graft survival and function) as those with normal bladders, although there is some possibility of malignant transformation in the intestinal segment used to augment the bladder in these patients.
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References
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Rigamonti W, Capizzi A, Zachello G, et al. Kidney transplantation into bladder augmentation or urinary diversion: long-Term results. Transplantation. 2005;80:1435–40.
Tarcan T, Bauer S, Olmedo E, Khoshbin S, Kelly M, Darbey M. Long-term followup of newborns with myelodysplasia and normal urodynamic findings: is followup necessary? J Urol. 2001;165:564–7.
Kaefer M, Pabby A, Kelly M, Darbey M, Bauer SB. Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomeningocele. J Urol. 1999;162:1068–71.
Hayashi Y, Yamataka A, Kaneyama K, Kato Y, Lane GJ, Miyano T. Review of 86 patients with myelodysplasia and neurogenic bladder who underwent sigmoidocolocystoplasty and were followed more than 10 years. J Urol. 2006;176:1806–9.
Lopez Pereira P, Moreno JA, Espinosa L, et al. Enterocystoplasty in children with neuropathic bladders: long-term follow-up. J Pediatr Urol. 2008;4:27–31.
Lima SVC, Araujo LAP, Vilar F, Lima RS. Nonsecretory intestinocystoplasty: a 15-year prospective study of 183 patients. J Urol. 2008;179:1113–7.
Yamzon J, Perin L, Koh CJ. Current status of tissue engineering in pediatric urology. Curr Opin Urol. 2008;18:4044–7.
Atala A. Regenerative medicine strategies. J Pediatr Surg. 2012;47:17–28.
Taghizadeh AK, Desai D, Ledermann SE, et al. Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children. BJU Int. 2007;100:1365–70.
Basiri A, Moghaddam SKR. Augmentation cystoplasty before and after renal transplantation: long-term results. Transplant Proc. 2002;34:2106–8.
Fontaine E, Gagnadoux MF, Niaudet P, Broyer M, Beurton D. Renal transplantation in children with augmentation cystoplasty: long-term results. J Urol. 1998;159:2110–3.
Nahas WC, Mazzucchi E, Arap MA, et al. Augmentation cystoplasty in renal transplantation: a good and safe option: experience with 25 cases. Urology. 2002;60:770–4.
Basiri A, Otookesh H, Rozita H, Simforoosh N, Moghaddam SMH. Kidney transplantation before or after augmentation cystoplasty in children with high-pressure neurogenic bladder. BUJ Int. 2008;103:86–8.
Kayler L, Kang D, Molmenti E, Howard R. Kidney transplant ureteroneocystostomy techniques and complications: review of the literature. Transplant Proc. 2010;42:1413–20.
Mendizabal S, Zamora I, Serrano A, et al. Renal transplantation in children with posterior urethral valves. Pediatr Nephrol. 2006;21:566–71.
Ross JH, Kay R, Novick AC, Hayes JM, Hodge EF, Streem SB. Long-term results of renal transplantation into the valve bladder. J Urol. 1994;151:1500–4.
Lopez Pereira P, Jaureguizar E, Martinez Urrutia MJ, Meseguer C, Navarro M. Does treatment of bladder dysfunction prior to renal transplant improve outcome in patients with posterior urethral valves. Pediatr Transplant. 2000;4:118–22.
Niuninga JE, Feitz WFJ, Van Dael KCML, De Gier RPE, Cornelissen EAM. Urological complications in pediatric renal transplantation. Eur Urol. 2001;39:598–602.
Otukesh H, Basiri A, Simfroosh N, Hoseini R, Fereshtehnejad S-M, Chalian M. Kidney transplantation in children with posterior urethral valves. Pediatr Transplant. 2008;12:516–9.
Sager C, Burek C, Duran V, et al. Outcome of renal transplant in patients with abnormal urinary tract. Pediatr Surg Int. 2011;27:423–30. This study compared RT outcomes among children who did not require lower urinary tract surgery (66 patients); those who required surgery but had preserved, adequate bladder function (46 patients); and those who required surgery because of bladder dysfunction (38 patients).
Basiri A, Otoukesh H, Simforoosh N, Rozita H, Farrokhi F. Kidney transplantation in children with augmentation cystoplasty. J Urol. 2007;178:274–7.
Traxel E, DeFoor W, Minevich E, et al. Low incidence of urinary tract infections following renal transplantation in children with bladder augmentation. J Urol. 2011;186:667–71. This study compared 17 patients undergoing AC and subsequent RT with a control group of transplant patients (17 patients) who were on CIC.
Pereira DA, Barroso Jr U, Machado P, et al. Effects of urinary tract infection in patients with bladder augmentation and kidney transplantation. J Urol. 2008;180:2607–10.
Lopez Pereira P, Ortiz R, Fernandez Camblor C, et al. Renal transplant outcome in children with an augmented bladder. Front Pediatr. 2013;1(42):1–4.
Soergel TM, Cain MP, Misseri R, Gardner TA, Koch MO, Rink RC. Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol. 2004;172:1649–52.
Husmann DA, Rathbun SR. Long-term follow up of enteric bladder augmentations: the risk for malignancy. J Pediatr Urol. 2008;4:381–5.
Higuchi TT, Granberg CF, Fox JA, Husmann DA. Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy. J Urol. 2010;184:2492–7. This clinical study suggests that AC does not increase the risk of malignancy over the inherent cancer risk associated with the underlying congenital abnormality, and that RT immunosuppression, irrespective of bladder treatment, is an independent risk factor for malignancy.
North American Pediatric Renal Trials and Collaborative Studies. 2010 Annual Report. www.NAPRTCS.org.
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Dr. Pedro López Pereira, Dr. Maria Jose Martínez Urrutia, Dr. Roberto Lobato, and Dr. Enrique Jaureguizar each declare no potential conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Pediatric Urology
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Pereira, P.L., Urrutia, M.J.M., Lobato, R. et al. Renal Transplantation in Augmented Bladders. Curr Urol Rep 15, 431 (2014). https://doi.org/10.1007/s11934-014-0431-4
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DOI: https://doi.org/10.1007/s11934-014-0431-4