The utility of native ureter in the management of ureteral complications in children after renal transplantation.

Autor: Serrell EC; University of Wisconsin, Madison, WI, USA., Su R; University of Wisconsin, Madison, WI, USA., O'Kelly F; University of Wisconsin, Madison, WI, USA.; University College Dublin, Dublin, Ireland., Semanik M; University of Wisconsin, Madison, WI, USA., Farhat WA; University of Wisconsin, Madison, WI, USA.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2021 Nov; Vol. 25 (7), pp. e14051. Date of Electronic Publication: 2021 May 30.
DOI: 10.1111/petr.14051
Abstrakt: Background: Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable.
Methods: With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications.
Results: Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant. Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12-19]).
Conclusions: Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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