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Nagahisa C, Unagami K, Banno T, Oki R, Yagisawa T, Kanzawa T, Hirai T, Omoto K, Ishida H, Takagi T. Kidney Transplantation After Multiple Urinary Tract Conversion with an Ileal Conduit: A Case Report. Transplant Proc 2023:S0041-1345(23)00252-X. [PMID: 37188608 DOI: 10.1016/j.transproceed.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Kidney transplantation (KTx) after urinary tract conversion surgery is extremely difficult due to several complications. In our case, KTx was performed after multiple operative procedures, including diversion urethrostomy. CASE REPORT The patient was a 46-year-old woman with a right atrophic kidney, an ectopic opening of the left ureter, and urethral dysplasia since birth. The patient underwent a right nephrectomy, left ureteral sigmoidostomy, Stamey surgery, augmentation ileocystoplasty, and left ureteroileostomy. Thereafter, she underwent nephrostomy, ileal conduit diversion, open sigmoid colectomy, and total cystectomy because of persistent urinary incontinence, sigmoid colon cancer, and recurrent cystitis. Her renal function gradually deteriorated, and hemodialysis was initiated. Before the KTx, she underwent laparoscopic left nephrectomy, an intraperitoneal adhesion debridement, and left ileal conduit resection. We dissected the left ileal conduit in the abdominal cavity and penetrated the anorectal side of the free ileal conduit into the wall of the right side of the abdomen. Thereafter, a kidney from a living donor was transplanted into the right iliac fossa through the existing right ileal conduit when the patient was 46 years old. The allograft function was stable without rejection for 2 years. CONCLUSIONS We report the case of a patient who underwent multiple urethral modifications followed by ileal conduit transfer and living donor KTx, which progressed without major postoperative complications.
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Affiliation(s)
- Chika Nagahisa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kohei Unagami
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan; Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan.
| | - Taro Banno
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Rikako Oki
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan; Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Takafumi Yagisawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Taichi Kanzawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihito Hirai
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Brubaker AL, Wu H, Lee A, Vuong P, Stoltz DJ, Chaudhuri A, James G, Grimm PC, Concepcion W, Gallo AE. Ureterostomy as an alternative to ileal conduits in pediatric kidney transplantation. Clin Transplant 2020; 34:e13777. [DOI: 10.1111/ctr.13777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Aleah L. Brubaker
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Hsi‐Yang Wu
- Division of Pediatric Urology Department of Urology Stanford University Palo Alto California
| | - Angela Lee
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Phoenix Vuong
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Daniel J. Stoltz
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Abanti Chaudhuri
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Gerri James
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Paul C. Grimm
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Waldo Concepcion
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Amy E. Gallo
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
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Diaz J, Chavers B, Chinnakotla S, Verghese P. Outcomes of kidney transplants in pediatric patients with the vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities association. Pediatr Transplant 2019; 23:e13341. [PMID: 30597716 DOI: 10.1111/petr.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 11/29/2022]
Abstract
In this single-center retrospective study, we analyzed kidney transplant outcomes in nine pediatric patients with VACTERL [vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities] association-making this the largest study of its kind. Of 743 pediatric kidney transplant recipients at our center (1980-2017), nine had documented diagnoses of VACTERL association. All nine had congenital anorectal malformations and renal anomalies, five had vertebral defects, and one had a bifid thumb and tracheoesophageal fistula. Renal anomalies included dysplasia (n = 6), aplasia (n = 3), and horseshoe kidney (n = 2). Congenital lower urinary tract anomalies included neurogenic bladder (n = 6), obstructive uropathy (n = 4), anovesicular fistula (n = 1), rectourethral fistula (n = 1), and posterior urethral valves (n = 1). Age at transplant ranged from 1.2 to 15 years (mean, 7.3; standard deviation [SD], 5.5); 6 (67%) were male, and 3 (33%) were female; 6 (67%) had a living related donor, and 3 (33%) had a deceased donor. The overall graft survival rate was 78% (range, 1.5 to 25.2 years; mean, 10.5; SD, 8.9). One month post-transplant, one recipient died with a functioning graft. At 3.7 years post-transplant, one graft failed because of recurrent pyelonephritis. Post-transplant urologic complications included pyelonephritis (n = 6), vesicoureteral reflux (n = 5), and graft hydronephrosis (n = 4). We conclude that pediatric patients with VACTERL association can be safely transplanted-careful patient selection with vigilance and intervention for pre- and post-transplant urologic complications is essential.
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Affiliation(s)
- Jessica Diaz
- University of Minnesota Medical School, Minneapolis, Minnesota.,Fairview Perioperative Services, Minneapolis, Minnesota
| | - Blanche Chavers
- Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Srinath Chinnakotla
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Priya Verghese
- Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Abstract
Urologic causes of end-stage renal disease are estimated between 25% and 40% of causes. The goal of renal transplantation in chronic kidney disease patients is to provide renal replacement therapy with less morbidity, better quality of life, and improved overall survival compared with dialysis. A patient's urologic history can be a significant source of problems related to infections, recurrence of disease, and surgical complications. Many of the urologic risks are modifiable. Proper evaluation and management can mitigate the potential problems after transplantation, and these patients with complex urologic problems are seen to have similar graft function outcomes.
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Long-term Outcome of 1-step Kidney Transplantation and Bladder Augmentation Procedure in Pediatric Patients. Transplantation 2018; 102:1014-1022. [PMID: 29319624 DOI: 10.1097/tp.0000000000002050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for bladder augmentation (BA) in kidney transplantation (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure. METHODS A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA. RESULTS Compared with 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate, 96.5 ± 17.1 versus 79.4 ± 16.6 mL/min at 0 to 6 months (P = 0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) versus 13% (3/22); and asymptomatic bacteriuria was more common: 100% versus 9% during the first 6 months (P < 0.001), 55% versus 9% (P = 0.02) and 66.6% versus 9% during the first and second years, respectively (P = 0.004). Urinary tract infection (UTI) incidence was also higher: 100% versus 23% during the first 6 months and 44% versus 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: estimated glomerular filtration rate was 47.7 ± 39.7 mL/min versus 69 ± 21.3 mL/min, with only 6 (66%) of 9 functioning grafts versus 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTIs in 2 patients. CONCLUSIONS Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy.
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children? Transplant Proc 2015; 47:1114-6. [DOI: 10.1016/j.transproceed.2014.10.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/28/2014] [Indexed: 11/23/2022]
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McLoughlin LC, Davis NF, Dowling CM, Power RE, Mohan P, Hickey DP, Smyth GP, Eng MM, Little DM. Outcome of deceased donor renal transplantation in patients with an ileal conduit. Clin Transplant 2014; 28:307-13. [DOI: 10.1111/ctr.12313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Niall F. Davis
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | | | - Richard E. Power
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | - Ponusamy Mohan
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | - David P. Hickey
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | - Gordon P. Smyth
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | - Molly M.P. Eng
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
| | - Dilly M. Little
- Department of Urology & Transplantation; Beaumont Hospital; Dublin Ireland
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Teng L, Wang C, Li J. Long-term outcome of simultaneous or staged urinary diversion and kidney transplantation. Urol Int 2013; 91:310-4. [PMID: 24009016 DOI: 10.1159/000351322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/13/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We retrospectively analyzed the long-term outcomes of simultaneous or staged urinary diversion and kidney transplantation. PATIENTS AND METHODS Between June 2001 and December 2012, 4 patients with dysfunctional bladder resulting from spina bifida (n = 3) or bladder contraction following urologic tuberculosis (n = 1) underwent cadaveric kidney transplantation and urinary diversion simultaneously (n = 3) or 6 months post-transplantation (n = 1). Urinary diversion consisted of cutaneous ureterostomy in 1 patient and ileal conduits in 3 patients. All patients were followed prospectively. RESULTS All 4 patients received deceased donor transplants. Median follow-up was 110.5 months (range 50-120). At the last follow-up, serum creatinine levels ranged from 1.1 to 1.8 mg/dl. One patient with a functioning graft died of severe cirrhosis 105 months following transplantation. Graft function remained stable without any severe complications in 3 patients. Hematoma (Clavien-Dindo grade IIIa) and urinary leakage (grade II) occurred in 1 patient in the early postoperative period, but no surgical revision was required. Two patients developed cytomegalovirus pneumonia. Urinary tract infection was a common problem in all patients. CONCLUSIONS For patients with lower urinary tract dysfunction, simultaneous kidney transplantation and urinary diversion with an ileal conduit may be a safe, feasible approach, with a satisfactory long-term outcome.
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Affiliation(s)
- Lichen Teng
- Department of Urology, Third Affiliated Hospital, Harbin Medical University, Harbin, China
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Zurowska AM, Fischbach M, Watson AR, Edefonti A, Stefanidis CJ. Clinical practice recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). Pediatr Nephrol 2013; 28:1739-48. [PMID: 23052647 PMCID: PMC3722439 DOI: 10.1007/s00467-012-2300-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 11/04/2022]
Abstract
BACKGROUND To provide recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). SETTING European Paediatric Dialysis Working Group. DATA SOURCES Literature on clinical studies involving infants with CKD5 (end stage renal failure) and consensus discussions within the group. RECOMMENDATIONS There has been an important change in attitudes towards offering RRT (renal replacement therapy) to both newborns and infants as data have accumulated on their improved survival and long-term outcomes. The management of this challenging group of patients differs in a number of ways from that of older children. The authors have summarised the basic recommendations for treating infants with CKD5 in order to support the multidisciplinary teams who endeavour on this difficult task.
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Affiliation(s)
- Aleksandra M Zurowska
- Department Paediatric & Adolescent Nephrology & Hypertension, Medical University of Gdansk, Ul. Debinki 7, 80-211, Gdansk, Poland.
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Al-Khudairi N, Riley P, Desai DY, Reid C, Marks SD, Mamode N. Interventions for impaired bladders in paediatric renal transplant recipients with lower urinary tract dysfunction. Transpl Int 2013; 26:428-34. [PMID: 23350943 DOI: 10.1111/tri.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 11/18/2012] [Accepted: 12/23/2012] [Indexed: 11/30/2022]
Abstract
Dysfunctional bladders in paediatric patients were thought to be a contraindication for renal transplantation, but advances in surgical techniques have meant that surgical correction can allow safe transplantation. This study compares the outcomes of renal transplantation for different interventions, and the timing of such interventions, in relation to transplantation. We identified all paediatric renal transplant recipients with LUTD that received intervention for their impaired bladders at two hospitals between 2002 and 2010. Outcome measures included patient and graft survival, perioperative complications, UTI incidence, acute rejection episodes and serum creatinine levels. A total of 288 allografts were transplanted, 77 were in 75 children with LUTD, of which 46 received intervention. Patient survival was 100% in the intervention group and 97% in the nonintervention group (P = 0.815). Death-censored graft survival was 96% and 100% respectively (P = 0.688). In the groups receiving intervention pretransplant or post-transplant, graft survival rates were 95% and 100% respectively (P = 0.476). The follow-up serum creatinine levels were higher in the pretransplant intervention group (P < 0.001). Interventions for dysfunctional bladders can be performed safely in paediatric renal transplant recipients. The mode of intervention and timing of intervention, in relation to transplant, do not influence outcomes if guided by careful assessment and investigation.
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Penna FJ, Elder JS. CKD and bladder problems in children. Adv Chronic Kidney Dis 2011; 18:362-9. [PMID: 21896378 DOI: 10.1053/j.ackd.2011.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 08/01/2011] [Accepted: 08/01/2011] [Indexed: 11/11/2022]
Abstract
Approximately 35% of children with CKD who require renal replacement therapy have a significant urological abnormality, including posterior urethral valves, a neuropathic bladder, prune belly syndrome, Hinman syndrome, or severe vesicoureteral reflux. In such children, abnormal bladder function can have a significant deleterious effect on the renal function. In children with bladder outlet obstruction, bladder compliance and capacity often are abnormal, and a sustained intravesical pressure of >40 cm H(2)O impedes drainage from the upper urinary tract. Consequently, in these conditions, regular evaluation with renal sonography, urodynamics, urine culture, and serum chemistry needs to be performed. Pediatric urological care needs to be coordinated with pediatric nephrologists. Many boys with posterior urethral valves have severe polyuria, resulting in chronic bladder overdistension, which is termed as valve bladder. In addition to behavioral modification during the day, such patients may benefit from overnight continuous bladder drainage, which has been shown to reduce hydronephrosis and stabilize or improve renal function in most cases. In children with a neuropathic bladder, detrusor-sphincter-dyssynergia is the most likely cause for upper tract deterioration due to secondary vesicoureteral reflux, hydronephrosis, and recurrent urinary tract infection (UTI). Pharmacologic bladder management and frequent intermittent catheterization are necessary. In some cases, augmentation cystoplasty is recommended; however, this procedure has many long-term risks, including UTI, metabolic acidosis, bladder calculi, spontaneous perforation, and malignancy. Nearly half of children with prune belly syndrome require renal replacement therapy. Hinman syndrome is a rare condition with severe detrusor-sphincter discoordination that results in urinary incontinence, encopresis, poor bladder emptying, and UTI, often resulting in renal impairment. Children undergoing evaluation for renal transplantation need a thorough evaluation of the lower urinary tract, mostly including a voiding cystourethrogram and urodynamic studies.
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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