Long-term outcomes of kidney transplant recipients with bladder dysfunction: A single-center study

Dushyanth Srinivasan, John T. Stoffel, Amit Mathur, Steven Kapeles, Kori Bradley, Randall S. Sung

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Long-term outcomes of kidney transplantation recipients with bladder dysfunction or prior bladder surgery are not well characterized. Material/Methods: Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. We found that 1652 recipients had normal bladder function, 80 had bladder dysfunction, and 21 had bladder substitute or urinary diversion. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. Results: Kaplan-Meier graft survival (p=.11) and patient survival (p=.18) were lower in recipients with bladder surgery but not statistically significant. Multivariate analysis demonstrated inferior graft survival (HR 3.57, 95% CI 1.06-12.1, p =0.04) and a trend towards inferior patient survival (HR 3.19, 95% CI .71-14.5, p=0.13) in recipients with bladder surgery. The major cause of graft failure was chronic rejection for normal function (17.1%) and bladder dysfunction (28.5%), and infection for bladder surgery (28.5%). Post-operative urinary infectious and surgical complications were higher in recipients with bladder dysfunction (35%) and substitutes (52.3%) compared with normal function (12.8%). Conclusions: Kidney transplant recipients with prior bladder surgery have an increased risk of graft failure and an increased risk of infectious urinary complications. These risks should be considered in recipient selection and post-transplant management.

Original languageEnglish (US)
Pages (from-to)222-234
Number of pages13
JournalAnnals of Transplantation
Volume21
DOIs
StatePublished - Apr 19 2016

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Urinary Bladder
Kidney
Transplants
Graft Survival
Survival
Transplant Recipients
Urinary Diversion
Kaplan-Meier Estimate
Kidney Transplantation
Multivariate Analysis
Infection

Keywords

  • Graft survival
  • Kidney transplantation
  • Urinary bladder diseases

ASJC Scopus subject areas

  • Transplantation

Cite this

Long-term outcomes of kidney transplant recipients with bladder dysfunction : A single-center study. / Srinivasan, Dushyanth; Stoffel, John T.; Mathur, Amit; Kapeles, Steven; Bradley, Kori; Sung, Randall S.

In: Annals of Transplantation, Vol. 21, 19.04.2016, p. 222-234.

Research output: Contribution to journalArticle

Srinivasan, Dushyanth ; Stoffel, John T. ; Mathur, Amit ; Kapeles, Steven ; Bradley, Kori ; Sung, Randall S. / Long-term outcomes of kidney transplant recipients with bladder dysfunction : A single-center study. In: Annals of Transplantation. 2016 ; Vol. 21. pp. 222-234.
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AB - Background: Long-term outcomes of kidney transplantation recipients with bladder dysfunction or prior bladder surgery are not well characterized. Material/Methods: Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. We found that 1652 recipients had normal bladder function, 80 had bladder dysfunction, and 21 had bladder substitute or urinary diversion. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. Results: Kaplan-Meier graft survival (p=.11) and patient survival (p=.18) were lower in recipients with bladder surgery but not statistically significant. Multivariate analysis demonstrated inferior graft survival (HR 3.57, 95% CI 1.06-12.1, p =0.04) and a trend towards inferior patient survival (HR 3.19, 95% CI .71-14.5, p=0.13) in recipients with bladder surgery. The major cause of graft failure was chronic rejection for normal function (17.1%) and bladder dysfunction (28.5%), and infection for bladder surgery (28.5%). Post-operative urinary infectious and surgical complications were higher in recipients with bladder dysfunction (35%) and substitutes (52.3%) compared with normal function (12.8%). Conclusions: Kidney transplant recipients with prior bladder surgery have an increased risk of graft failure and an increased risk of infectious urinary complications. These risks should be considered in recipient selection and post-transplant management.

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