Vesicoureteral reflux after kidney transplantation in children

Background. The prevalence and significance of vesicoureteral reflux (WR) a fter kidney transplantation in adults varies between authors and there have been few reports in children. Methods. We conducted a retrospective study in a single-centre paediatric c ohort. Fifty-five of the 84 children who underwent kidney transplantation o ver a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation. Results, VUR into the graft was present in 58% of the patients. Graft funct ion and incidence of urinary-tract infections were similar in the two group s, independent of VUR. After having excluded infections attributed to the p resence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with WR (P = 0.017 and P = 0.0039 respectively). None of the eight patients with WR treated with antibiotic prophylaxis after a fir st acute pyelonephritis (APN) episode presented subsequent APN after 4.4+/- 3.3 years on therapy. Conclusions. VUR to the graft occurred in more than half paediatric renal t ransplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with WR.