Renal Transplant and Reconstructive Surgery

摘要

Not many years ago, children with structural or functional abnormalities of the lower urinary tract were considered to be very high-risk recipients and were denied renal transplant (RT). However, the development of novel surgical reconstructive techniques (eg, augmentation cystoplasty, Mitrofanoff and Monti techniques) has improved these RT outcome for these patients. Nevertheless, some concerns have been raised that bladder augmentation in these patients may increase the risk of complications, predominantly urinary tract infections (UTIs), urologic complications, bladder cancer, and allograft dysfunction and loss. However, the higher incidence of UTIs in these patients is more related to clean intermittent catheterization noncompliance or vesicoureteral reflux to the native kidney or graft than to the augmented bladder itself and usually does not lead to impairment of graft function. Despite these possible complications and the fact that our current knowledge is based on studies with limited numbers of patients, children who have undergone reconstructive surgeries can be transplanted with an outcome in graft function and survival that is similar to those with normal bladders.