Pediatric Urology Division, Urology Department, Cairo Children's Hospital, Cairo University, Cairo, Egypt.
Urology Department, Minia Nephrology and Urology University Hospital, Minia University, Minia, Egypt.
Pediatr Transplant. 2020 Sep;24(6):e13735. doi: 10.1111/petr.13735. Epub 2020 May 30.
Much is still unknown about LUT function after receiving renal graft. Graft function was the main focus of different studies discussing the same issue. However, these studies ignored the effects of the graft on lower tract function and more demand for bladder cycling and growth of the child. Therefore, we aimed at evaluating the LUT function after RT into patients with LUTD. We enrolled a retrospective cohort of 83 live renal transplant children with LUTD. The 44 patients in Group (A) had a defunctionalized bladder, and the 39 patients in Group (B) had underlying LUT pathology. All patients had clinical and urodynamic evaluation of LUT functions at least 1 year after RT. We found that the improvement in patients with impaired bladder compliance was 73% in Group (A) and 60% in Group (B), with no statistically significant difference between the study groups. In Group (B), there was statistically significant worsening of MFP (8.4%) and mean PVR (79.9%) after RT. In Group (A), mild but stable significant improvement of all clinical and urodynamic parameters was observed. Serum creatinine was significantly worse in patients with pathological LUTD compared with those with defunctionalized bladder but without significant effect on graft survival. All LUT variables seemed to have no adverse effect on graft survival except for use of CIC and augmented bladder. Incident UTI independent of LUT variables accounted for 20% of graft creatinine change.
接受肾移植后，人们对 LUT 功能仍知之甚少。不同研究讨论同一问题时，主要关注的是移植物功能。然而，这些研究忽略了移植物对下尿路功能的影响，以及对膀胱周期性活动和儿童生长的更多需求。因此，我们旨在评估 LUTD 患者接受 RT 后的 LUT 功能。我们纳入了 83 例患有 LUTD 的活肾移植儿童的回顾性队列。A 组的 44 例患者存在无功能膀胱，B 组的 39 例患者存在 LUT 病理。所有患者在 RT 后至少 1 年进行了 LUT 功能的临床和尿动力学评估。我们发现，膀胱顺应性受损患者的改善情况在 A 组为 73%，在 B 组为 60%，两组间无统计学差异。在 B 组，MFP（8.4%）和平均 PVR（79.9%）在 RT 后有统计学显著恶化。在 A 组，观察到所有临床和尿动力学参数均有轻度但稳定的显著改善。与无功能膀胱但无 LUT 病变的患者相比，LUT 病变患者的血清肌酐明显更差，但对移植物存活率无显著影响。除了使用 CIC 和增强膀胱外，所有 LUT 变量似乎对移植物存活率均无不良影响。与 LUT 变量无关的 UTI 发生率占移植物肌酐变化的 20%。
