Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Urol. 2013 Aug;190(2):678-82. doi: 10.1016/j.juro.2013.02.019. Epub 2013 Feb 14.
Historically surgeons caring for children with urinary diversion for bladder outlet obstruction have routinely performed undiversion before renal transplantation. We hypothesized that patients undergoing transplantation into a diverted system would have outcomes similar to those undergoing transplantation into a normal bladder. We review the outcomes of patients with and without diversion undergoing kidney transplantation at our institution.
We retrospectively studied a cohort of children undergoing renal transplant between 1993 and 2006. Patients whose etiology of end-stage renal disease was either obstructive uropathy or renal dysplasia were included. Patients with less than 5 years of followup were excluded from the analysis. Four groups were assembled, ie controls with renal dysplasia and no history of obstructive uropathy undergoing transplant (group 1), patients with obstructive uropathy not diverted at transplant (group 2), patients with obstructive uropathy diverted at transplant (group 3) and patients with obstructive uropathy augmented before transplant (group 4). The groups were compared for outcomes of frequency of urinary tract infection, renal graft function and graft loss.
Of the 80 subjects eligible based on diagnostic criteria 43 had completed 5 years of followup. There was no significant difference between groups based on age (p = 0.508), renal function as measured by glomerular filtration rate (p = 0.526) or creatinine (p = 0.612), or frequency of urinary tract infections (p = 0.083). Only 1 patient in the cohort suffered graft loss.
Based on frequency of urinary tract infection, renal function and graft loss 5 years after transplant, there appears to be no added risk to transplanting a kidney into a diverted system.
有历史数据显示，为膀胱出口梗阻而行尿流改道术的儿童的外科医生通常会在肾移植前进行再通术。我们假设，在已分流系统中接受移植的患者与在正常膀胱中接受移植的患者的结果相似。我们回顾了我们机构中接受和未接受分流术的患者进行肾移植的结果。
我们回顾性地研究了 1993 年至 2006 年间接受肾移植的一组儿童患者。纳入的患者终末期肾病的病因是尿路梗阻或肾发育不良。未接受 5 年以上随访的患者被排除在分析之外。我们组建了四个组，即没有尿路梗阻史的肾发育不良患者接受移植（组 1）、移植时未分流的梗阻性尿路病患者（组 2）、移植时分流的梗阻性尿路病患者（组 3）和移植前接受过增强的梗阻性尿路病患者（组 4）。比较各组尿路感染的频率、肾移植功能和移植失败的结果。
根据诊断标准，80 名符合条件的患者中有 43 名完成了 5 年的随访。各组之间在年龄（p = 0.508）、肾小球滤过率（p = 0.526）或肌酐（p = 0.612）测量的肾功能或尿路感染频率（p = 0.083）方面无显著差异。队列中只有 1 名患者发生移植失败。
根据尿路感染频率、肾功能和移植后 5 年的移植失败情况，将肾脏移植到分流系统中似乎没有增加风险。
