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19–22 APRIL, 2017, BARCELONA, SPAIN
09:59–10:02
S6-6 (PP)
LONG-TERM OUTCOME OF ADULT RENAL
TRANSPLANTATION IN PATIENT WITH CONGENITAL
LOWER URINARY TRACT MALFORMATIONS:
A MULTICENTER STUDY
Stéphane MARCHAL
1
, Nicolas KALFA
2
, François IBORRA
1
, Lionel BADET
3
,
Georges KARAM
4
, Lucas BROUDEUR
4
, Julien BRANCHEREAU
4
and Rodolphe THURET
1
1) Montpellier University Hospital, Adult Urology, Montpellier, FRANCE - 2) Montpellier University Hospital, Pediatric
surgery, Montpellier, FRANCE - 3) Lyon University Hospital, Adult Urology, Lyon, FRANCE - 4) Nantes University
Hospital, Adult Urology, Nantes, FRANCE
PURPOSE
Lower urinary tract malformations managed in infancy represent a particular group of kidney trans-
plantation since it may impair the final function of the graft. Data in literature remains sparse. The
aim of this study was to report the feasibility and long-term results of renal transplantation during
adulthood in patients with a congenital lower urinary tract malformation.
MATERIAL AND METHODS
A retrospective multicenter study from 3 French renal transplant centers included 123 transplanta-
tions in 112 patients with lower urinary tract malformations (1996-2016). Graft and patient survivals
and complications were analyzed. The results were stratified according to the underlying uropathy
and type of initial management during childhood.
RESULTS
Mean age at transplantation was 32,1 years (±11,2). Were included posterior urethral valves (n=
49), spina bifida (n=21), central neurogenic bladders (n=13), bladder exstrophy (n=14), Prune Belly
(n=12), Hinman syndrome (n=6), urogenital sinus (n=4) and others (n=4). The mean follow up
was 7,2years. Overall the 1, 5, 10 and 15 years patients survival was 97.4%, 93.0%, 89.4% and
80.0%. Grafts survival at 1, 5, 10, 15 and 20 years was 96.6%, 87.6%, 77.3%, 60.6% and 36.4%.
Enterocystoplasty and continent urinary diversions exposed grafts to more frequent acute pyelone-
phritis (p=0.02). There were no differences on graft survival when transplantation was performed
in enterocystoplasty or urinary diversions compared to a native bladder provided a well conducted
bladder management.
CONCLUSIONS
Lower urinary tract malformations should be considered for renal transplantation as any other cause
of end stage renal disease. Despite previous surgeries and possible bladder dysfunction, these
patients should not be excluded from renal transplantation programs. Even if enterocystoplasty and
continent urinary diversions exposed grafts to more frequent acute pyelonephritis, patients and graft
survival rates at 10 years are similar to other kidney transplantation.