Outcome of patients with vesicoureteral reflux after renal transplantation: the effect of pretransplantation surgery on posttransplant urinary tract infections.

OBJECTIVES

We evaluated the relation of vesicoureteral reflux, pretransplant nephrectomy, and prior ureteral reimplant with respect to posttransplant urinary tract infection and graft survival.

METHODS

From 1984 to 1995, 820 renal transplants were performed. Thirty-six (4%) patients had documented vesicoureteral reflux. The patients were divided into three groups: Group I, N = 10 (28%) underwent ureteral reimplantation prior to transplantation; Group II, N = 8 (22%) had bilateral nephrectomy prior to transplantation; and Group III, N = 18 (50%) had persistent reflux at the time of transplantation.

RESULTS

Graft survival at 3 years was 50% (18/36). Patient survival was 94% (34/36). The overall incidence of urinary tract infection was 56% (20/36). Complicated urinary tract infection was seen in 28% (10/36) and uncomplicated urinary tract infection in 47% (17/36) of the patients. The incidence of both complicated and uncomplicated urinary tract infection was lower in Group I. However, graft survival was lower in Group I patients. Overall graft survival was significantly lower in patients with vesicoureteral reflux compared with the rest of the group.

CONCLUSIONS

The incidence of urinary tract infection did not appear to be altered significantly whether the patients had bilateral nephrectomy or persistent vesicoureteral reflux. However, those patients who had ureteral reimplantation had fewer episodes of infection. Nephrectomy prior to transplantation should be performed selectively.