Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Clin Transplant. 2011 Mar-Apr;25(2):329-33. doi: 10.1111/j.1399-0012.2010.01242.x.
Recurrent transplant pyelonephritis (RTP) secondary to vesico-ureteral reflux (VUR) to the transplant kidney (KTx) remains a significant cause of infectious complications with impact on patient and graft outcomes. Our objective was to verify the safety and efficacy of transurethral injection of Durasphere(®) to relieve RTP secondary to VUR after renal transplantation.
Between June 2004 and July 2008, eight patients with RTP (defined as two or more episodes of pyelonephritis after transplantation) and VUR to the KTx were treated with subureteral injections of Durasphere(®). The mean age at surgery was 38.8 ± 13.8 yr (23-65). The patients were followed regularly every six months. The mean interval between the KTx and the treatment was 76 ± 74.1 (10-238 months). The mean follow-up was 22.3 ± 16.1 months (8-57 months).
Six patients (75%) were free of pyelonephritis during a mean period of follow-up of 23.2 ± 17.1 months (8-57 months). Two of them had no VUR and four cases presented with G II VUR (pre-operative G IV three cases and one case G III). In one case, symptomatic recurrent cystitis made a second treatment necessary. This patient remained free of infections for three yr after the first treatment and for 18 months after the second treatment. Of the remaining two patients, one had six episodes of RTP before treatment in a period of three yr and only two episodes after treatment in two yr of follow-up. The last case had a new episode of pyelonephritis five months after treatment.
Transurethral injection therapy with Durasphere(®) is a safe and effective minimally invasive treatment option for KTx patients with recurrent RTP. A second treatment seems to be necessary in some cases.
由于移植肾（KTx）的膀胱输尿管反流（VUR）导致的复发性移植肾盂肾炎（RTP）仍然是感染并发症的重要原因，对患者和移植物的预后有影响。我们的目的是验证经尿道注射 Durasphere（®）治疗肾移植后 VUR 继发 RTP 的安全性和有效性。
2004 年 6 月至 2008 年 7 月，8 例 RTP（定义为移植后两次或两次以上肾盂肾炎发作）和 KTx 伴有 VUR 的患者接受了 Durasphere（®）的输尿管下注射治疗。手术时的平均年龄为 38.8 ± 13.8 岁（23-65 岁）。患者定期每 6 个月随访一次。KTx 和治疗之间的平均间隔为 76 ± 74.1（10-238 个月）。平均随访时间为 22.3 ± 16.1 个月（8-57 个月）。
6 名患者（75%）在 23.2 ± 17.1 个月（8-57 个月）的平均随访期间无肾盂肾炎发作。其中 2 例无 VUR，4 例 VUR 为 G II（术前 3 例 G IV，1 例 G III）。在 1 例患者中，症状性复发性膀胱炎需要进行第二次治疗。该患者在第一次治疗后 3 年和第二次治疗后 18 个月内均无感染。其余 2 例患者中有 1 例在 3 年期间有 6 次 RTP 发作，在 2 年随访期间仅 2 次发作。最后一例患者在治疗后 5 个月发生新的肾盂肾炎。
经尿道注射 Durasphere（®）治疗是治疗复发性 RTP 的一种安全有效的微创治疗选择。在某些情况下，似乎需要进行第二次治疗。
