Predictors for abnormal voiding cystourethrography in pediatric patients undergoing renal transplant evaluation

The role of pretransplant voiding cystourethrography (VCUG) in adults has b een questioned owing to the low prevalence of abnormal findings. As there a re no studies evaluating the relevance of VCUG in children and because vesi coureteral reflux (VUR) occurs with higher prevalence in children, we perfo rmed a retrospective cohort study to identify any predictors for abnormal V CUG. We reviewed 271 consecutive renal transplants performed between 1980 a nd 1997, By logistic regression, the etiology of end-stage renal disease (E SRD) and age at transplantation (Tx) were strong predictors of abnormal pre transplant VCUG findings in children. On multi-variate analysis, children w ith urologic etiologies of renal disease had an odds ratio (OR) of 16.5 (p <0.0001) for abnormal VCUG as compared to children with non-urologic or acq uired causes of ESRD. Similarly, children transplanted when younger than 8 yr of age had an OR of 3.0 (p = 0.0043) for having an abnormal VCUG when co mpared with older children. Finally, our analysis suggests that children wi th abnormal pretransplant VCUG findings, whether or not pretransplant surgi cal correction was performed, were over three-fold more likely to require p ost-transplant urologic surgery when compared to children with normal pretr ansplant VCUG. We conclude that urologic causes of ESRD and age under 8 yr are strong independent predictors of abnormal pretransplant VCUG findings, and that these findings are of clinical relevance both in deciding whether to pursue pretransplant VCUG and in the post-transplant course of the patie nt.