Maison Patrick Opoku Manu, Smit Shaun, McCulloch Mignon, Gajjar Priya, Nourse Peter, Thomson Dave, Muller Elmi, Millar Alastair, Numanoglu Alp, Kahn Delawir, Lazarus John
Division of Urology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Division of Pediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Pediatr Transplant. 2017 Nov;21(7). doi: 10.1111/petr.13045. Epub 2017 Aug 20.
Urological complications which develop post-renal transplantation can be associated with significant morbidity especially in children. We evaluated the occurrence and management of all urological complications in a series of unstented pediatric renal transplants in a tertiary pediatric hospital. We reviewed the medical records of children who underwent unstented renal transplant between January 1996 and December 2014. Postoperative urological complications and the outcomes of their management were analyzed. A total of 160 unstented renal transplants were performed, and 32 urological complications were noted in 29 transplants (18%). There were 20 boys and nine girls with an age range of 2.5 years to 18.4 years. Nine (31%) of these patients had LUTD. The most common complication was VUR occurring in 17 patients (10.6%). Urine leaks occurred in six patients (3.8%) and ureteric obstruction in six patients (3.8%), and three patients (1.9%) had unexplained hydronephrosis. Loss of graft occurred in three patients (1.9%), and one patient died from sepsis post-uretero-ureterostomy. Patients with LUTD had more urological complications (P = .037). Unstenting is feasible in most pediatric renal transplants. LUTD is associated with a higher incidence of urological complications, especially VUR.
肾移植术后出现的泌尿系统并发症可能会导致严重的发病率，尤其是在儿童中。我们评估了一家三级儿童医院一系列无支架小儿肾移植中所有泌尿系统并发症的发生情况及处理方法。我们回顾了1996年1月至2014年12月期间接受无支架肾移植的儿童的病历。分析了术后泌尿系统并发症及其处理结果。共进行了160例无支架肾移植，29例移植（18%）中发现32例泌尿系统并发症。有20名男孩和9名女孩，年龄范围为2.5岁至18.4岁。这些患者中有9例（31%）患有下尿路疾病（LUTD）。最常见的并发症是膀胱输尿管反流（VUR），发生在17例患者中（10.6%）。6例患者（3.8%）出现尿漏，6例患者（3.8%）出现输尿管梗阻，3例患者（1.9%）出现不明原因肾积水。3例患者（1.9%）移植肾丢失，1例患者在输尿管输尿管吻合术后死于败血症。患有LUTD的患者泌尿系统并发症更多（P = 0.037）。在大多数小儿肾移植中不放置支架是可行的。LUTD与泌尿系统并发症的发生率较高有关，尤其是VUR。
