Kidney transplantation for treating lower urinary tract abnormality A follow-up in 4 cases / 中国组织工程研究

ABSTRACT

BACKGROUND: Lower urinary tract abnormality (LUTA) can lead to end-stage renal disease (ESRD). However, insufficient attention has been paid to these patients in China, and they are usually thought unsuitable for kidney transplantation because of high incidences of graft dysfunction and septic complication.OBJECTIVE: To explore the characteristics and postoperative follow-up after kidney transplantation in four patients with LUTA.DESIGN, TIME AND SETTING: A retrospective analysis of LUTA cases was performed from July 2002 to June 2006 at the Organ Transplantation Center of Chinese PLA, Second Affiliated Hospital of General Hospital of Chinese PLA.PARTICIPANTS: Four ESRD cases of LUTA, who received allograft kidney transplantation.METHODS: Four cases of LUTA experienced detail evaluation before kidney transplantation. Ureter was reimplanted into the original bladder during transplantation and suprapubic cystostomy was performed as urinary drainage.MAIN OUTCOME MEASURES: Patient and graft survival, graft function, urinary tract infection (UTI) and graft rejection were supervised after surgery and quality of life was evaluated.RESULTS: Two patients recovered well with normal renal function and no rejection. Despite the moderate but easily controlled UTI, they handled the urinary diversion well and were satisfied with the quality of life. One patient experienced an acute rejection 17 days after transplantation and survived with functional graft until now after the rejection was reversed. One patient lost the graft for repeated hemorrhage at the site of vascular anastomosis, and then returned to hematodialysis.CONCLUSION: Kidney transplantation is suitable but special for patients with LUTA. Careful evaluation before transplantation, suitable urinary drainage and rigorous follow-up after surgery are keys to the success of kidney transplantation for this subgroup of patients.