Kidney transplant in patients with abnormal bladder: Experience of tertiary care center in developing country-Is the outcome same?
| Autor: | Samit Chaturvedi, R. Maheshwari, Rahul Yadav, Anant Kumar, Pragnesh Desai, A. Gulia |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
kidney transplant
medicine.medical_specialty medicine.medical_treatment Urinary system 030232 urology & nephrology lcsh:Surgery 030230 surgery urologic and male genital diseases 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Biopsy medicine Abnormal bladder Dialysis Transplantation Creatinine Kidney Rehabilitation Urinary bladder medicine.diagnostic_test business.industry lcsh:RD1-811 Surgery medicine.anatomical_structure chemistry business urinary tract infection |
| Zdroj: | Indian Journal of Transplantation, Vol 12, Iss 2, Pp 136-142 (2018) |
| ISSN: | 2212-0025 2212-0017 |
| Popis: | Background: Fifteen percent of adults and 20%–30% of pediatric patients develop renal failure, results from structural urological abnormalities. Successful renal transplantation depends partly on a bladder which has adequate capacity, good compliance, and efficient voluntary emptying. Urinary bladder rehabilitation with augmentation or diversion is necessary before transplant in these patients to achieve good graft outcome. We, hereby report our last 10 years' experience of such patients undergoing kidney transplant in abnormal bladder. Materials and Methods: A total of 14 patients underwent renal transplantation in rehabilitated bladder from 2006 to 2016. Demographic details, prereconstruction bladder and urodynamic findings, and type of pretransplant reconstruction were recorded. Posttransplant creatinine levels, graft survival at 7 days, 3 months, 1 year, and 3 years were recorded. Results: Mean (± standard deviation) serum creatinine posttransplant at 7 days, 3 months, 1 year, and 3 years was 0.9 (±0.20), 1.58 (±0.65), 1.92 (±1.02), and 2.47 (1.17) mg/dl, respectively. Four patients developed rejection within 6 months of transplant. Kidney biopsy was suggestive of acute cellular rejection in all cases, which was treated successfully. At three years follow-up, four patients who had rejection-have rising creatinine levels and diminishing renal functions. No patient needed dialysis support till last follow-up. All these four patients had rejection, urinary tract infection (UTI) episodes and pyelonephritis in the past. Conclusion: Native bladder is the best reservoir for urinary storage and drainage. The main cause of graft dysfunction in rehabilitated bladder is UTI as a result of poor hygiene, contamination during clean intermittent self-catheterization (CISC) and noncompliance for CISC leading to high residual urine. Controlling frequent attacks of UTI posttransplant is essential, otherwise long-term graft survival and function will deteriorate faster and might trigger rejection. |
| Databáze: | OpenAIRE |
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