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肾移植术后膀胱输尿管反流手术矫正对发热性尿路感染的疗效:一项单中心回顾性研究

The Effectiveness of the Surgical Correction of Vesicoureteral Reflux on Febrile Urinary Tract Infections after a Kidney Transplant: A Single-Center Retrospective Study.

作者信息

Varaschin Andre E, Gomar Gabriella G, Rocco Amanda M, Hokazono Silvia R, Garlet Quelen I, Oliveira Cláudia S

机构信息

Instituto de Pesquisa Pele Pequeno Principe, Curitiba 80250-060, PR, Brazil.

Faculdades Pequeno Principe, Curitiba 80230-020, PR, Brazil.

出版信息

J Clin Med. 2024 Sep 6;13(17):5295. doi: 10.3390/jcm13175295.

Abstract

: Vesicoureteral reflux (VUR) is considered one of the major causes of post-renal transplant febrile urinary tract infections (UTI), leading to impaired renal function and the premature loss of the renal graft. We aimed to evaluate whether surgical VUR correction, such as open redo ureteric reimplantation, could be an option for treatment and provide better outcomes in post-transplant care for patients with UTI compared to their pre-VUR correction clinical state. : Our study presents a retrospective analysis of 10 kidney transplant recipients with febrile UTI at the Renal Transplant Service of a Brazilian public hospital from 2010 to 2020. We selected patients who primarily underwent a surgical correction of post-transplant VUR, which was corrected by extravesical reimplantation without a stent in all patients by the same professional surgeon. : From 710 patients who received kidney transplants, 10 patients (1.4%) suffered from febrile UTI post-transplant and underwent surgical correction for VUR. Despite the study's limitations, such as its retrospective nature and limited sample size, the efficacy of open extravesical ureteral reimplantation in reducing post-operative febrile UTI in renal transplant patients was observed. : As febrile UTI can contribute significantly to patient mortality after kidney transplantation and VUR emerges as a major cause of post-transplant febrile UTI, it is essential to treat it and consider the surgical outcome. This study emphasizes the timely detection and effective treatment of VUR via extravesical techniques to reduce febrile UTI occurrences post-transplant and it contributes insights into the role of surgical interventions in addressing VUR-related complications post-kidney transplantation.

摘要

膀胱输尿管反流(VUR)被认为是肾移植术后发热性尿路感染(UTI)的主要原因之一,可导致肾功能受损和肾移植过早丢失。我们旨在评估手术纠正VUR,如开放性再次输尿管再植术,是否可作为一种治疗选择,并与VUR纠正前的临床状态相比,为UTI患者的移植后护理提供更好的结果。

我们的研究对2010年至2020年巴西一家公立医院肾移植科的10例发热性UTI肾移植受者进行了回顾性分析。我们选择了主要接受移植后VUR手术纠正的患者,所有患者均由同一位专业外科医生通过无支架的膀胱外再植术进行纠正。

在710例接受肾移植的患者中,10例(1.4%)移植后发生发热性UTI并接受了VUR手术纠正。尽管该研究存在局限性,如回顾性性质和样本量有限,但观察到开放性膀胱外输尿管再植术在降低肾移植患者术后发热性UTI方面的疗效。

由于发热性UTI可显著导致肾移植后患者死亡,且VUR是移植后发热性UTI的主要原因,因此治疗VUR并考虑手术结果至关重要。本研究强调通过膀胱外技术及时检测和有效治疗VUR,以减少移植后发热性UTI的发生,并为手术干预在解决肾移植后VUR相关并发症中的作用提供了见解。

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