[Vesicoureteral reflux after pediatric kidney transplantation].

OBJECTIVES

We analyze the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients.

METHODS

This retrospective analysis examined the prevalence of posttransplant vesicoureteral reflux in a total of 201 kidney transplants performed in children at our centre between 1978 and 2006. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and posttransplant problems related to vesicoureteral reflux. We also analyzed the form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux.

RESULTS

Twelve patients (5.9%) needed surgery to correct reflux to the graft (10 children) or to the native kidney (2 children). Reflux presented as urinary tract infection in 11 children and progressive graft failure in 1. Urethrovesical disorders that favoured vesicoureteral reflux were present in 10 patients (noncompliant bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 12 patients, whereas 6-month voiding cystourethrograms showed resolution in 10 patients and reduction in the degree of reflux in 2.

CONCLUSION

The high percentage of posttransplant vesicoureteral reflux in pediatric patients was related with higher frequency of vesicourethral pathology in children who received the transplant. In children with pretransplant urethrovesical anomalies we recommend an initial technique which utilizes a longer submucosal tunnel during implantation, such as the Lich-Gregoir.