Skip to main content

Advertisement

SpringerLink
Log in

Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

We reviewed our experience with renal transplantation (RTx) in children weighing <15 kg to determine if the presence of lower urinary tract dysfunction (LUTD) influenced the outcome.

Methods

Between 1987 and 2012, 68 RTx were performed in patients weighing less than 15 kg, including 17 with associated LUTD and 51 without. We detailed the lower urinary tract management in these patients, and compared graft survival rates and estimated clearance 12 and 60 months after RTx between groups.

Results

None of the patients without LUTD required any lower urinary tract surgery vs 8 out of 17 (47 %) with LUTD (p = 0.0001). The latter included a temporary incontinent urinary diversion in 5 cases (29 %), namely 2 vesicostomies and 3 cutaneous ureterostomies. After comparable follow-ups, there was no difference in patient survival, graft survival, and glomerular filtration rates between groups.

Conclusions

Provided that there is appropriate bladder management, a concomitant LUTD does not adversely influence the outcome of RTx in patients weighing less than 15 kg. However, 50 % of our patients required lower urinary tract reconstruction and, in 30 %, a temporary incontinent urinary diversion was placed at RTx, since lower urinary tract function could not be assessed reliably, the patient was not collaborative enough to be involved in a voiding program, and/or the RTx was prioritized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ESRD:

End-stage renal disease

RTx:

Renal transplantation

LUTD:

Lower urinary tract dysfunction

CIC:

Clean intermittent catheterization

References

  1. Benfield MR, McDonald RA, Bartosh S, Ho PL, Harmon W (2003) Changing trends in pediatric transplantation: 2001 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 7:321–335

    Article  PubMed  Google Scholar 

  2. Millan MT, Sarwal MM, Lemley KV, Yorgin P, Orlandi P, So S, Alexander S, Salvatierra O Jr (2000) A 100 % 2-year graft survival can be attained in high-risk 15-kg or smaller infant recipients of kidney allografts. Arch Surg 135:1063–1068

    Article  CAS  PubMed  Google Scholar 

  3. Mickelson JJ, MacNeily AE, Leblanc J, White C, Gourlay WA (2006) Renal transplantation in children 15 Kg or less: the British Columbia Children’s Hospital experience. J Urol 176:1797–1800

    Article  CAS  PubMed  Google Scholar 

  4. Morita K, Iwami D, Hotta K, Shimoda N, Miura M, Watarai Y, Hoshii S, Obikane K, Nakashima T, Sasaki S, Nonomura K (2009) Pediatric kidney transplantation is safe and available for patients with urological anomalies as well as those with primary renal diseases. Pediatr Transplant 13:200–205

    Article  PubMed  Google Scholar 

  5. Nahas WC, Antonopoulos IM, Piovesan AC, Pereira LM, Kanashiro H, David-Neto E, Ianhez LE, Srougi M (2008) Comparison of renal transplantation outcomes in children with and without bladder dysfunction. A customized approach equals the difference. J Urol 179:712–716

    Article  PubMed  Google Scholar 

  6. Taghizadeh AK, Desai D, Ledermann SE, Shroff R, Marks SD, Koffman G, Duffy PG, Cuckow PM (2007) Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children. BJU Int 100:1365–1370

    Article  PubMed  Google Scholar 

  7. DeFoor W, Minevich E, McEnery P, Tackett L, Reeves D, Sheldon C (2003) Lower urinary tract reconstruction is safe and effective in children with end stage renal disease. J Urol 170:1497–1500

    Article  PubMed  Google Scholar 

  8. Guerra L, Leonard M, Castagnetti M (2014) Best practice in the assessment of bladder function in infants. Ther Adv Urol 6:148–164

    Article  PubMed Central  PubMed  Google Scholar 

  9. Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843

    Article  PubMed  Google Scholar 

  10. Castagnetti M, Zhapa E, Berrettini A, Ghirardo G, Murer L, Zanon GF, Rigamonti W (2010) Lower urinary tract symptoms (LUTS) after renal transplant in non-urologic anuric patients. Pediatr Transplant 14:859–862

    Article  PubMed  Google Scholar 

  11. Singer JS, Zaid U, Gritsch HA, Lerman SE, Churchill BM (2009) Selective use of voiding cystourethrography in children undergoing renal transplant evaluation. J Urol 182:1158–1162

    Article  PubMed  Google Scholar 

  12. Castagnetti M, Angelini L, Ghirardo G, Zucchetta P, Gamba P, Zanon G, Murer L, Rigamonti W (2014) Ureteral complications after renal transplant in children: timing of presentation, and their open and endoscopic management. Pediatr Transplant 18:150–154

    Article  PubMed  Google Scholar 

  13. Ruiz E, Cateriano JE, Lobos P, de Badiola FI, Boer M, Moldes J, Puigdevall J, Ferraris J (2006) Kidney transplantation in small children with live related donors: 20 years of experience. J Pediatr Urol 2:373–379

    Article  PubMed  Google Scholar 

  14. Elsheemy MS, Shouman AM, Shoukry AI, Soaida S, Salah DM, Yousef AM, Morsi HA, Fadel FI, Sadek SZ (2014) Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less. J Pediatr Urol 10:737–743

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have neither financial relationships relevant to this article to declare nor any conflict of interest.

Author information

Authors and Affiliations

  1. Paediatric Nephrology Unit, Department of Paediatrics, University Hospital of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Giulia Ghirardo & Luisa Murer

  2. Paediatric Surgery Unit, University Hospital of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Paola Midrio, PierGiorgio Gamba & GiovanniFranco Zanon

  3. Nuclear Medicine, University Hospital of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Pietro Zucchetta

  4. Section of Paediatric Urology, Urology Unit, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani, 2, 35128, Padua, Italy

    Marco Castagnetti

Authors
  1. Giulia Ghirardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Midrio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pietro Zucchetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. PierGiorgio Gamba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. GiovanniFranco Zanon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luisa Murer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco Castagnetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Castagnetti.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghirardo, G., Midrio, P., Zucchetta, P. et al. Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?. Pediatr Nephrol 30, 1337–1342 (2015). https://doi.org/10.1007/s00467-015-3047-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-015-3047-0

Keywords

Search

Navigation