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Adrenal and Renal Physiology, and Medical Renal Disease
1072
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE
Adrenal and Renal Physiology, and Medical Renal Disease Outcome of Renal Transplantation in Adult Patients With Augmented Bladders M. Blanco, J. Medina, M. Pamplona, N. Miranda, E. Gonzalez, J. F. Aguirre, A. Andres, O. Leiva and J. M. Morales Department of Urology, Doce de Octubre University Hospital, Madrid, Spain Transplant Proc 2009; 41: 2382–2384.
Objective: We studied the long-term renal graft functions, survivals, and complications among patients with augmented bladders. Patients and Methods: Between 1976 and 2008, we performed 6/2600 renal transplantations in patients with augmented bladders. The mean patient age was 52 years. The cause of end-stage renal disease was chronic interstitial kidney disease in all patients, being secondary to lower urinary tract dysfunction. The etiology of bladder dysfunction was tuberculosis in 4 cases, bladder exstrophy in 1, and myelomeningocele in 1. Enterocystoplasty had been performed at a mean of 19 years prior to transplantation. The ureter was implanted into the native ureter in 5 cases and the bowel segment in 1 case. Results: With a mean follow-up of 56 months (range, 20 –100 months), the overall graft survival was 50%. Three grafts were lost due to venous thrombosis (n ⫽ 1), and chronic allograft nephropathy (n ⫽ 2) at 37 and 100 months posttransplantation. No patient died during follow-up. Mean serum creatinine was 1.44 mg/dL with Modification of Diet in Renal Disease (MDRD) clearance of 76 mL/min/1.73 m(2). One fistula that caused obstructive uropathy and 2 cases of migration of a double J catheter were among the surgical complications. These patients showed a mean of 7 episodes of uncomplicated urinary infections. Only 1 patient was rehospitalized due to a complicated urinary tract infection. Conclusions: Patients with enterocystoplasty and renal transplantation show a greater risk of urinary tract infections, albeit mostly uncomplicated. Despite this, the long-term results are acceptable. Editorial Comment: The authors analyzed 6 patients who underwent augmentation cystoplasty, 4 for chronic infection due to tuberculosis and 2 for congenital abnormalities. The transplant ureter was anastomosed to the native ureter in 5 patients and to the bowel segment in 1. Graft survival was approximately 50% at 4.5 years. One patient required intermittent catheterization and 1 had a chronic indwelling catheter. The authors report that urinary tract infections were not a particular problem. However, there is little information given on whether drug dosages needed to be altered. Of concern is the graft survival at 4 years, which would appear to be less than what one would expect. However, in the properly selected patient this is a viable option. W. Scott McDougal, M.D.
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE
Adrenal and Renal Physiology, and Medical Renal Disease Outcome of Renal Transplantation in Adult Patients With Augmented Bladders M. Blanco, J. Medina, M. Pamplona, N. Miranda, E. Gonzalez, J. F. Aguirre, A. Andres, O. Leiva and J. M. Morales Department of Urology, Doce de Octubre University Hospital, Madrid, Spain Transplant Proc 2009; 41: 2382–2384.
Objective: We studied the long-term renal graft functions, survivals, and complications among patients with augmented bladders. Patients and Methods: Between 1976 and 2008, we performed 6/2600 renal transplantations in patients with augmented bladders. The mean patient age was 52 years. The cause of end-stage renal disease was chronic interstitial kidney disease in all patients, being secondary to lower urinary tract dysfunction. The etiology of bladder dysfunction was tuberculosis in 4 cases, bladder exstrophy in 1, and myelomeningocele in 1. Enterocystoplasty had been performed at a mean of 19 years prior to transplantation. The ureter was implanted into the native ureter in 5 cases and the bowel segment in 1 case. Results: With a mean follow-up of 56 months (range, 20 –100 months), the overall graft survival was 50%. Three grafts were lost due to venous thrombosis (n ⫽ 1), and chronic allograft nephropathy (n ⫽ 2) at 37 and 100 months posttransplantation. No patient died during follow-up. Mean serum creatinine was 1.44 mg/dL with Modification of Diet in Renal Disease (MDRD) clearance of 76 mL/min/1.73 m(2). One fistula that caused obstructive uropathy and 2 cases of migration of a double J catheter were among the surgical complications. These patients showed a mean of 7 episodes of uncomplicated urinary infections. Only 1 patient was rehospitalized due to a complicated urinary tract infection. Conclusions: Patients with enterocystoplasty and renal transplantation show a greater risk of urinary tract infections, albeit mostly uncomplicated. Despite this, the long-term results are acceptable. Editorial Comment: The authors analyzed 6 patients who underwent augmentation cystoplasty, 4 for chronic infection due to tuberculosis and 2 for congenital abnormalities. The transplant ureter was anastomosed to the native ureter in 5 patients and to the bowel segment in 1. Graft survival was approximately 50% at 4.5 years. One patient required intermittent catheterization and 1 had a chronic indwelling catheter. The authors report that urinary tract infections were not a particular problem. However, there is little information given on whether drug dosages needed to be altered. Of concern is the graft survival at 4 years, which would appear to be less than what one would expect. However, in the properly selected patient this is a viable option. W. Scott McDougal, M.D.