VESICOURETERAL REFLUX AFTER KIDNEY-TRANSPLANTATION - CLINICAL-SIGNIFICANCE IN THE MEDIUM TO LONG-TERM

103 patients who received a cyclosporine-treated primary cadaver kidne y transplant (TX) at our center between 1985 and 1989, whose graft sur vived for more than 1 year and who accepted to undergo voiding cystogr aphy after TX were analyzed and grouped according to the highest grade (regardless to whether active or passive) of vesicoureteral reflux (V UR): group 0, absent (n = 14); group 1-2, grade I or II (n = 62); grou p 3, grade III (n = 27). Patient follow-up ranged from 5 to 10 (median 7) years. Patient and graft survivals and prevalence of hypertension (defined as the persistent need of antihypertensive therapy), did not differ significantly between groups (Mantel-Cox test p: n.s. in all ca ses. GFR (Cockroft and Gault) and proteinuria were evaluated with ANOV A for repeated measures at 1, 2, 3, 4 and 5 years in the 96 patients ( group 0: 13, group 1-2: 56, group 3: 27) whose grafts lasted for 5 yea rs or more. Neither GFR values (p: n.s.) nor GFR behaviour over time ( p: n.s.) differed between groups, although a progressive decline of GF R was noted in all groups (p < 0.002). Proteinuria neither showed any significant difference between groups in values (p: n.s.) or behaviour over time (p: n.s.), nor any trend in behaviour over time in all grou ps as a whole (p: n.s.). Finally, in the first 5 years after TX the 3 groups did not differ for number of urinary tract infections (UTIs) (m ean value for all patients: 2.5, range 0-22, episodes/pt/5 years) (p: n.s.), or for number of UTIs with leukocyturia (mean 0.6, range 0-6, e pisodes/pt/5 years) (p: n.s.), or for number of febrile UTIs (mean 0.3 , range 0-5, episodes/pt/5 years) (p: n.s.). or for number of UTIs wit h sepsis (mean 0.1, range 0-2, episodes/pt/5 years) (p: n.s.). The sam e results were obtained when, instead of episodes/pt/5 years, percenta ges of patients without or with 1 or more of such episodes in the same period were considered. In conclusion, WR does not seem to be hazardo us for the transplanted kidney in the medium to long-term.