University of Wisconsin, Madison, WI, USA.
University College Dublin, Dublin, Ireland.
Pediatr Transplant. 2021 Nov;25(7):e14051. doi: 10.1111/petr.14051. Epub 2021 May 30.
Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable.
With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications.
Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant. Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12-19]).
Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.
儿童肾移植后输尿管并发症是发病率的主要来源。治疗方法复杂且多样。
在获得机构审查委员会批准后，回顾性分析了 1997 年至 2017 年间接受肾移植且至少随访 2 年、因移植后输尿管并发症而接受干预的<18 岁患者的健康记录。
在 136 名患者中，17 名（13%）因狭窄（n=3）、反流（n=12）或两者（n=2）需要进行输尿管干预。移植中位时间为 10.5 年（3.1-14.7）。重建中位时间为移植后 10 个月（7-15）。6 名（35%）患者存在膀胱先前存在的病理。5 例狭窄患者中有 4 例至少进行了一次内镜球囊扩张。最终的治疗方法包括再植、将自体输尿管与移植输尿管吻合、将肾盂与自体输尿管吻合、多次内镜介入后行 Boari 皮瓣、或多次内镜介入失败。14 例 VUR 患者行再植术（n=5）、自体输尿管与移植输尿管吻合术（n=4）、肾盂与自体输尿管吻合术（n=4），1 例行移植输尿管 Deflux 内镜注射。只有 1 例患者因输尿管并发症导致移植肾无功能。所有患者在随访时均存活（中位随访时间 17 年[12-19]）。
移植后输尿管反流和狭窄是儿童肾移植后的严重并发症，可能需要手术治疗。在我们的人群中，分别有 10%和 4%的患者需要反流或狭窄重建。内镜介入很少成功。对于输尿管并发症的管理，应考虑将自体输尿管用于超过三分之二患者的输尿管重建。
