RENAL-TRANSPLANTATION IN CHILDREN WITH POSTERIOR URETHRAL VALVES REVISITED - A 10-YEAR FOLLOW-UP

Purpose: Renal transplantation is safe and effective for end stage ren al disease in children with posterior urethral valves. We previously r eported our 5-year post-transplantation results in boys with posterior urethral valves and matched controls. Graft survival was similar. How ever, we were concerned about elevated serum creatinine and the potent ial detrimental effects of hostile bladder dynamics in these children. We performed this study to determine whether our concern would be sub stantiated. Materials and Methods: We retrospectively analyzed the cli nical records and computerized transplantation database in 268 boys yo unger than 19 years who underwent renal transplantation from May 1968 through November 1988. The 18 children with posterior urethral valves were compared to a nonobstructed cohort of 18 boys in regard to age, n umber of transplants, donor type and immunosuppression. All children h ad at least 10 years of followup (range 10 to 19). Results: The 10-yea r post-transplant patient survival in the posterior urethral valves an d control groups was 94 and 100%, while 10-year graft survival was 54 and 41%, respectively. There was no statistically significant differen ce in graft survival when comparing immunosuppression type, donor sour ce and pre-transplant proximal urinary diversion. The 10-year mean ser um creatinine was 2.3 and 2.0 mg./dl. in the posterior urethral valve and control groups, respectively (not statistically significant). Conc lusions: Our renal transplantation results in children with posterior urethral valves are comparable to those in children with nonobstructiv e end stage renal disease. The 10-year graft survival was better but n ot statistically significant in the posterior urethral valve group, wh ile serum creatinine was similar. Our concern regarding renal transpla ntation in children with posterior urethral valves was not substantiat ed.