Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation

Sophoclis Alexopoulos, Amy Lightner, Waldo Concepcion, Marilyn Rose, Kathrine Salcedo-Concepcion, Oscar Salvatierra

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background. Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences. Methods. A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity. Results. One-year patient and graft survival rates were 100%. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7%) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5% and 84% of expected, respectively. Conclusions. In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.

Original languageEnglish (US)
Pages (from-to)452-456
Number of pages5
JournalTransplantation
Volume91
Issue number4
DOIs
StatePublished - Feb 27 2011
Externally publishedYes

Fingerprint

Urinary Bladder
Pediatrics
Kidney
Graft Survival
Urinary Tract Infections
Stents
Unnecessary Procedures
Neurogenic Urinary Bladder
Urinary Catheters
Vesico-Ureteral Reflux
Cystoscopy
Graft Rejection
Urinary Tract
Catheterization
Kidney Transplantation
Chronic Kidney Failure
Catheters
Survival Rate
Joints
Anti-Bacterial Agents

Keywords

  • Defunctionalized urinary bladder
  • Kidney transplant
  • Pediatric

ASJC Scopus subject areas

  • Transplantation

Cite this

Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation. / Alexopoulos, Sophoclis; Lightner, Amy; Concepcion, Waldo; Rose, Marilyn; Salcedo-Concepcion, Kathrine; Salvatierra, Oscar.

In: Transplantation, Vol. 91, No. 4, 27.02.2011, p. 452-456.

Research output: Contribution to journalArticle

Alexopoulos, Sophoclis ; Lightner, Amy ; Concepcion, Waldo ; Rose, Marilyn ; Salcedo-Concepcion, Kathrine ; Salvatierra, Oscar. / Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation. In: Transplantation. 2011 ; Vol. 91, No. 4. pp. 452-456.
@article{b1c61474c5a3470486f8133e6c5245b3,
title = "Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation",
abstract = "Background. Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences. Methods. A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity. Results. One-year patient and graft survival rates were 100{\%}. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7{\%}) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5{\%} and 84{\%} of expected, respectively. Conclusions. In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.",
keywords = "Defunctionalized urinary bladder, Kidney transplant, Pediatric",
author = "Sophoclis Alexopoulos and Amy Lightner and Waldo Concepcion and Marilyn Rose and Kathrine Salcedo-Concepcion and Oscar Salvatierra",
year = "2011",
month = "2",
day = "27",
doi = "10.1097/TP.0b013e318204381a",
language = "English (US)",
volume = "91",
pages = "452--456",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation

AU - Alexopoulos, Sophoclis

AU - Lightner, Amy

AU - Concepcion, Waldo

AU - Rose, Marilyn

AU - Salcedo-Concepcion, Kathrine

AU - Salvatierra, Oscar

PY - 2011/2/27

Y1 - 2011/2/27

N2 - Background. Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences. Methods. A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity. Results. One-year patient and graft survival rates were 100%. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7%) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5% and 84% of expected, respectively. Conclusions. In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.

AB - Background. Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences. Methods. A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity. Results. One-year patient and graft survival rates were 100%. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7%) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5% and 84% of expected, respectively. Conclusions. In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.

KW - Defunctionalized urinary bladder

KW - Kidney transplant

KW - Pediatric

UR - http://www.scopus.com/inward/record.url?scp=79951678912&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951678912&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e318204381a

DO - 10.1097/TP.0b013e318204381a

M3 - Article

C2 - 21283065

AN - SCOPUS:79951678912

VL - 91

SP - 452

EP - 456

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 4

ER -