Renal transplantation in children with severe lower urinary tract dysfunction

Purpose: Renal transplantation in children with end stage renal disease due to congenital urological malformations has traditionally been associated w ith a poor outcome compared to transplantation in those with a normal urina ry tract. In addition, the optimal urological treatment for such children r emains unclear. To address these issues, we retrospectively reviewed our ex perience with renal transplantation in this population. Materials and Methods: Between 1986 and 1948, 12 boys and 6 girls a mean ag e of 8.4 years with a severe dysfunctional lower urinary tract underwent a total of 15 living related and 6 cadaveric renal transplantations. Urologic al anomalies included posterior urethral valves in 8 cases, urogenital sinu s anomalies in 4, the prune-belly syndrome in 2, and complete bladder dupli cation, ureterocele, lipomeningocele and the VATER syndrome in 1 each. In 1 1 children (61%) bladder augmentation or continent urinary diversion was pe rformed, 2 (11%) have an intestinal conduit and 5 (28%) have a transplant i nto the native bladder. Results: In this group patient and overall allograft survival was 100 and 8 1%, respectively. These values mere the same in all children who underwent renal transplantation at our center during this era. In the 17 children wit h a functioning transplant mean serum creatinine was 1.4 mg./dl. Technical complications occurred in 4 patients (22%), including transplant ureteral o bstruction in 2 as well as intestinal conduit stomal stenosis and Mitrofano ff stomal incontinence. Conclusions: Renal transplantation may be successfully performed in childre n with end stage renal disease due to severe lower urinary tract dysfunctio n. Bladder reconstruction, which may be required in the majority of these c ases, appears to be safe when performed before or after the transplant. A m ultidisciplinary team approach to surgery is advantageous.