प्रत्यारोपण प्रौद्योगिकी एवं अनुसंधान

Renal Transplantation in Patients with Lower Urinary Tract Dysfunction: A Single Center Experience from a Developing Country

Abstract

Rehan Mohsin, Altaf Hashmi, Muhammed Mubarak, Asad Shehzad, Gohar Sultan, Nazish Ghazanfar, Syed Ali Anwer Naqvi and Syed Adeeb ul Hassan Rizvi

Objectives: Historically, patients with lower urinary tract dysfunction (LUTD) were considered poor candidates for renal transplantation (RT). We aimed to review our experience with this procedure for its safety and efficacy.

Methods: We reviewed the case records of patients with LUTD who underwent RT at our center. Graft and patient survival were analyzed.

Results: Out of 2053 RTs, 26 (1.2%) patients had LUTD as the primary cause of end-stage renal disease (ESRD). All patients underwent cystourethroscopy prior to transplantation, had abnormal bladders and all underwent bladder augmentation. Only 16 (61.5%) patients had urodynamic (UDN) evaluation prior to transplantation. Pretransplantation augmentation cystoplasty (AC) was performed in 24 (92.3%) patients, and post-RT in two (7.7%). Mitrofanoff channel was made in 25 (96.1%) patients using appendix in 14 (56%) patients and native ureter in 11 (44%). Double-J (DJ) stents were placed in all patients peroperatively. All patients developed 156 episodes of urinary tract infections (UTIs), with an average of 6 UTIs/ patient. All patients except three are maintaining their graft function within acceptable limits. We observed 100% patient and graft survival rates in this series.

Conclusions: In conclusion, RT combined with AC is a feasible option for patients with LUTD with good results in the medium term and should be explored in selected patients.