Ascar Priscila Cardoso Braz, Penedo Camila Correa, Genzani Camila Penteado, Fonseca Mariana Janiques Barcia Magalhães, Scaranti Vanessa, Feltran Luciana Santis, de Camargo Maria Fernanda Carvalho, de Souza Leão Jovelino Quintino, Nogueira Paulo Cesar Koch
Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, São Paulo, Brazil.
Department of Pediatrics, Federal University of São Paulo, UNIFESP, São Paulo, Brazil.
Pediatr Transplant. 2025 Feb;29(1):e70017. doi: 10.1111/petr.70017.
Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of kidney failure in childhood. Renal transplantation is the modality of treatment used for kidney failure that promotes improved quality of life for pediatric patients. It is believed that patients with CAKUT are more predisposed to developing graft reflux in the post-transplant period, but its influence on graft survival is poorly understood. A comparative analysis between patients with and without VUR in the graft was made to determine the impact of reflux on graft function and survival in pediatric CAKUT patients.
A retrospective case-control study of patients undergoing first renal transplantation between April 2008 and October 2021 was done. The study included CAKUT individuals who underwent voiding cystourethrogram after transplantation. Patients were stratified into a group without reflux in the transplanted kidney (controls) and a group with reflux (cases). Six-year graft and patient survivals were calculated and compared using Kaplan-Meier curves and the log-rank test.
A total of 257 CAKUT patients were studied. Of this group, 63 (24%) underwent voiding cystourethrogram after transplantation, and 48 (76%) had reflux in the transplanted kidney. Estimated six-year survival of the graft was 72% in the control group versus 96% in the case group (log-rank 0.889). The median follow-up time after transplantation in years was 7.6 in controls and 6.6 in cases (p = 0.383).
Pediatric patients with CAKUT who presented reflux in transplanted kidneys had similar graft and patient survivals compared to patients without reflux.
先天性肾脏和尿路异常（CAKUT）是儿童肾衰竭的常见原因。肾移植是用于治疗肾衰竭的一种方式，可提高儿科患者的生活质量。据信，患有CAKUT的患者在移植后更容易发生移植肾反流，但其对移植肾存活的影响尚不清楚。对移植肾有或无膀胱输尿管反流（VUR）的患者进行了比较分析，以确定反流对儿科CAKUT患者移植肾功能和存活的影响。
对2008年4月至2021年10月期间接受首次肾移植的患者进行回顾性病例对照研究。该研究纳入了移植后接受排尿性膀胱尿道造影的CAKUT患者。患者被分为移植肾无反流组（对照组）和有反流组（病例组）。使用Kaplan-Meier曲线和对数秩检验计算并比较6年移植肾和患者生存率。
共研究了257例CAKUT患者。在该组中，63例（24%）在移植后接受了排尿性膀胱尿道造影，其中48例（76%）移植肾有反流。对照组移植肾的估计6年生存率为72%，而病例组为96%（对数秩检验，P=0.889）。对照组移植后的中位随访时间为7.6年，病例组为6.6年（P=0.383）。
与无反流的患者相比，移植肾出现反流的儿科CAKUT患者的移植肾和患者生存率相似。
