Trends in Renal Transplantation Rates in Patients with Congenital Urinary Tract Disorders

Long-term outcomes of kidney replacement therapy in Australians with prune belly syndrome

AIM

The aim of this study was to describe long-term outcomes of kidney replacement therapy (KRT) in Australians with prune belly syndrome in comparison to a control group of congenital kidney disease.

METHODS

We identified all Australians treated with KRT between 1977 and 2021 with a diagnosis of PBS from the Australia and New Zealand Dialysis and Transplant Registry.

RESULTS

We identified 37 males (no females) who commenced KRT at a median age of 17 years (range 1-45). At initiation of KRT treatment, 54% of patients were on haemodialysis, 30% on peritoneal dialysis and 16% received a pre-emptive kidney transplant. Forty-eight kidney transplants (35 first, 11 second and 2 third grafts) occurred, of which 48% were from deceased donors. Median age at first transplant was 21 years (range 2-47). Graft survival at 1, 5 and 10 years for first grafts was 91%, 71% and 51%, respectively (range 6 days to 36 years). Three men reported parenthood at median age 35 years. There were 10 deaths reported at a median age of 37 years (range 17-49). Reported aetiology was cardiac death (50%), malignancy (20%), dialysis cessation (10%) and uncertain cause (20%). Compared to an age and gender-matched control group of people with congenital kidney dysplasia, Australians with PBS had equivalent peritoneal dialysis technique survival, but slightly better transplant graft and overall survival.

CONCLUSION

Prune belly syndrome has marked variation in outcomes from KRT, but overall, these were equivalent or better than a matched control group with congenital kidney disease, including use of peritoneal dialysis (despite lack of abdominal wall musculature).

Trasplante renal en paciente con pared abdominal compleja: síndrome de abdomen en ciruela pasa

Introducción. Se presenta un paciente con falla renal crónica secundaria a hidroureteronefrosis bilateral, con antecedente de síndrome de abdomen en ciruela pasa (prune belly), en quien se realiza trasplante renal. El objetivo de este reporte de caso es exponer una anomalía congénita, con baja incidencia mundial y en menor proporción asociado a trasplante renal, con énfasis en la dificultad para la técnica quirúrgica dada por la hipoplasia de los músculos de la pared abdominal. Métodos. Revisión de Historia clínica, Consentimiento Informado. Búsqueda de la literatura. Caso clínico. En cirugía se identifica ausencia de músculos de la pared abdominal y fibrosis de las venas Iliaca externa y común derecha. Se realiza abordaje bajo técnica de Gibson contralateral, con trasplante renal sin complicaciones. Presentó adecuada evolución en seguimiento ambulatorio. Discusión. El síndrome de abdomen en ciruela pasa (prune belly) es una anomalía congénita de baja incidencia, con pocos reportes asociados a trasplante renal. El reto quirúrgico está dado por la ausencia de músculos de la pared abdominal, que aumentan los riesgos por posibles complicaciones, como la lesión de los vasos epigástricos inferiores. Para el cierre de pared abdominal en trasplante renal, se describe en dos planos, que en este caso se realiza sobre fascia muscular y piel. Aun siendo un reto, el paciente presenta adecuada evolución postoperatoria.

Prune belly syndrome: current perspectives

Prune belly syndrome (PBS) is a rare but morbid congenital disease, classically defined by a triad of cardinal features that includes cryptorchidism, urinary tract dilation and laxity of the abdominal wall musculature. Children often require numerous surgical interventions including bilateral orchidopexy as well as individually tailored urinary tract and abdominal wall reconstruction. Along with the classic features, patients with PBS often experience gastrointestinal, orthopedic, and cardiopulmonary comorbidities.