背景:继发于尿路病变的终末期肾病(ESRD)患者在肾移植前潜在的尿路异常的解决,历史上一直得到支持,认为这将有助于防止感染并发症和移植物丢失。我们建议早期进行肾脏移植并进行短暂性膀胱造口术,将尿路病变的解决推迟到移植后时期。这项研究的目的是评估膀胱造口术患儿的肾脏移植结果。
方法:回顾性研究,进行了多中心研究,包括所有18岁以下接受膀胱造口术肾移植的患者,在2005年1月至2020年12月期间,并进行了至少一年的随访。与膀胱造口术的适应症和时机相关的数据,直到移植,移植后并发症,收集尿路感染(UTI)和移植物存活率。
结果:在研究期间进行的758次移植中,16例患者符合纳入标准。移植时的平均年龄为58个月(范围20-151),平均体重为13.5Kg(范围8.4-20)。从膀胱造口术到肾移植的平均时间为30个月(范围0-70)。有2例(12.5%)输尿管并发症需要再次手术。在8例患者(50%)中发现了18例UTI发作,占每个患者-年随访0.4UTI。在任何情况下,UTI均未导致移植物丢失。5例患者(31.3%)在移植后1-91个月进行了尿路重建。移植后平均随访44.8个月(范围13-200),膀胱造口术患者的平均肌酐清除率为86.6ml/min/1.73m2,平均血清肌酐水平为0.6mg/dl.移植物成活率为100%。
结论:早期肾脏移植入膀胱造口术可以解决ESRD,避免与透析相关的有害影响。由于UTI的比率较低,我们没有发现因感染并发症引起的移植物丢失.这种策略可以在不延迟肾脏移植的情况下进行仔细的计划和更好的泌尿道重建时机。
结论:膀胱造口术治疗小儿肾移植似乎是一种安全有效的治疗方法。UTI发生率与文献中报道的有纠正的泌尿异常的患者在没有尿流改道的情况下接受肾移植的患者相似。
Resolution of underlying urinary tract anomalies prior to kidney transplantation in patients with end stage renal disease (ESRD) secondary to uropathy, has been historically supported under the argument that this would help prevent infectious complications and graft loss. We propose to perform earlier kidney transplantation with a transient
vesicostomy, deferring resolution of the uropathy to the post-transplantation period. The aim of this study was to evaluate the outcomes of kidney transplantation in children with a
vesicostomy.
A retrospective, multicenter study was performed including all patients under 18 years of age who underwent kidney transplantation with a vesicostomy, between January 2005 and December 2020 and had at least one year of follow up. Data related with the indication and timing of
vesicostomy, time until transplantation, post-transplantation complications, urinary tract infections (UTI) and graft survival rate were collected.
Of the 758 transplantations performed in the study period, 16 patients met the inclusion criteria. Mean age at transplantation was 58 months (range 20-151), and mean weight was 13.5 Kg (range 8.4-20). Mean time from
vesicostomy to kidney transplantation was 30 months (range 0-70). There were 2 (12.5%) ureteral complications that required reoperation. Eighteen episodes of UTI were identified in 8 patients (50%), accounting for 0.4 UTIs per patient-year of follow-up. UTIs did not lead to graft loss in any of the cases. Urinary tract reconstruction was performed in 5 patients (31.3%) at an interval of 1-91 months post-transplantation. After a mean follow-up of 44.8 months (range 13-200) from transplantation, patients with
vesicostomy had a mean creatinine clearance of 86.6 ml/min/1.73 m2, with a mean serum creatinine level of 0.6 mg/dl. Graft survival rate was 100%.
Early kidney transplantation into a vesicostomy permits a resolution of the ESRD, avoiding deleterious effects related to dialysis. With a low rate of UTIs, we found no graft loss due to infectious complications. This strategy permits careful planning and better timing for the urinary tract reconstruction without delaying kidney transplantation.
Kidney transplantation in pediatric patients with vesicostomy seems to be a safe and effective strategy. UTI rate was similar to that reported in the literature of patients with corrected urinary anomalies undergoing kidney transplantation without urinary diversion.