https://eutils.ncbi.nlm.nih.gov/entrez/eutils/efetch.fcgi?db=pubmed&id=35352393&retmode=xml&tool=Litmetric&email=readroberts32@gmail.com&api_key=61f08fa0b96a73de8c900d749fcb997acc09 353523932022070620221101
1442-20422972022JulInternational journal of urology : official journal of the Japanese Urological AssociationInt J UrolVesicoureteral reflux treatment following kidney transplantation potentially prevents graft function deterioration and allows long-term graft survival.699706699-70610.1111/iju.14876The impact of vesicoureteral reflux post-kidney transplantation on graft survival remains unclear, and guidelines on appropriate vesicoureteral reflux management post-kidney transplantation are lacking. For this reason, we conducted a retrospective study on the impact of vesicoureteral reflux and its treatment on graft survival.We evaluated 347 consecutive kidney transplantation recipients, who also underwent a ureteroneocystostomy, between 1996 and 2012.Vesicoureteral reflux was diagnosed in 55 cases (15.9%), with a median post-kidney transplantation duration of 50 months (range 0-172 months). Among these, 22 were monitored, 17 underwent transurethral collagen injections, and 16 received a ureteroneocystostomy. The 10-year graft survival rate was significantly lower in recipients with vesicoureteral reflux (68.9%) than in those without vesicoureteral reflux (84.4%) (P = 0.0165). Moreover, among the vesicoureteral reflux recipients, the 10-year graft survival rate was significantly higher in those whose vesicoureteral reflux was cured (80.1%) than in those whose vesicoureteral reflux persisted (53.6%) (P = 0.0062). Multivariate analysis showed that vesicoureteral reflux was significantly associated with both overall and death-censored graft loss (odds ratio 3.737 and 3.685; P = 0.0015 and P = 0.0052, respectively). Lastly, the incidence of interstitial fibrosis and tubular atrophy was higher in recipients with vesicoureteral reflux than in those without vesicoureteral reflux (P = 0.0009).Post-kidney transplantation vesicoureteral reflux has a negative impact on long-term graft survival, and that treatment prevents graft deterioration. From the perspective of maintaining long-term graft function in kidney recipients, vesicoureteral reflux may be one of the most important complications to be addressed.© 2022 The Japanese Urological Association.HiroseTakayukiTDepartment of Urology, Hokkaido University Hospital, Japan.HottaKiyohikoK0000-0002-8080-5962Department of Urology, Hokkaido University Hospital, Japan.HaradaHiroshiH0000-0001-5121-6686Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan.TanabeTatsuTDepartment of Urology, Hokkaido University Hospital, Japan.SasakiHajimeHDepartment of Urology, Hokkaido University Hospital, Japan.ShinoharaNobuoNDepartment of Urology, Hokkaido University Hospital, Japan.engJournal Article20220329
AustraliaInt J Urol94402370919-8172IMInt J Urol. 2022 Oct;29(10):1244-1245. doi: 10.1111/iju.1497235844179Graft SurvivalHumansKidney Transplantationadverse effectsRetrospective StudiesUreterVesico-Ureteral Refluxetiologyprevention & controlsurgeryallograft survivalkidney transplantationurinary complicationsvesicoureteral reflux202112252022315202233160202277602022330545ppublish3535239310.1111/iju.14876ReferencesOhba K, Matsuo M, Noguchi M et al. Clinicopathological study of vesicoureteral reflux (VUR)-associated pyelonephritis in renal transplantation. Clin. Transplant. 2004; 18(Suppl. 11): 34-8.Coulthard MG, Keir MJ. Reflux nephropathy in kidney transplants, demonstrated by dimercaptosuccinic acid scanning. Transplantation 2006; 82: 205-10.Cendron M. Reflux nephropathy. J. Pediatr. Urol. 2008; 4: 414-21.Özdemir BH, Ayva Ş, Özdemir G et al. Renal allograft with calcium oxalate deposition: association with urinary tract infection and development of interstitial fibrosis. Exp. Clin. Transplant. 2018; 16(Suppl. 1): 126-30.Akioka Y, Chikamoto H, Horita S et al. Screening of vesicoureteral reflux in pediatric patients with kidney transplantation showing non-specific interstitial fibrosis and tubular atrophy with interstitial Tamm-Horsfall protein deposits in protocol allograft biopsy. Clin. Transplant. 2009; 23(Suppl. 20): 2-5.Barry JM, Hatch DA. Parallel incision, unstented extravesical ureteroneocystostomy: followup of 203 kidney transplants. J. Urol. 1985; 134: 249-51.Mathew TH, Kincaid-Smith P, Vikraman P. Risks of vesicoureteric reflux in the transplanted kidney. N. Engl. J. Med. 1977; 297: 414-8.Dinckan A, Aliosmanoglu I, Kocak H et al. Surgical correction of vesico-ureteric reflux for recurrent febrile urinary tract infections after kidney transplantation. BJU Int. 2013; 112: E366-71.Lee S, Moon HH, Kim T-S et al. Presence of vesicoureteral reflux in the graft kidney does not adversely affect long-term graft outcome in kidney transplant recipients. Transplant. Proc. 2013; 45: 2984-7.Favi E, Spagnoletti G, Valentini AL et al. Long-term clinical impact of vesicoureteral reflux in kidney transplantation. Transplant. Proc. 2009; 41: 1218-20.Jung GO, Chu JM, Park JB et al. Clinical significance of Posttransplantation vesicoureteral reflux during short-term period after kidney transplantation. Transplant. Proc. 2008; 40: 2339-41.Margreiter M, Györi GP, Böhmig GA, Trubel S, Mühlbacher F, Steininger R. Value of routine voiding cystourethrography after renal transplantation. Am. J. Transplant. 2012; 13: 130-5.Molenaar NM, Minnee RC, Bemelman FJ, Idu MM. Vesicoureteral reflux in kidney transplantation. Prog. Transplant. 2017; 27: 196-9.Miyakita H, Hayashi Y, Mitsui T et al. Guidelines for the medical management of pediatric vesicoureteral reflux. Int. J. Urol. 2020; 27: 480-90.Hotta K, Miura M, Wada Y et al. Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation. Int. J. Urol. 2017; 24: 314-9.International Reflux Study Committee. Medical versus surgical treatment of primary vesicoureteral reflux. Pediatrics 1981; 67: 392-400.Roufosse C, Simmonds N, Groningen M et al. A 2018 reference guide to the Banff classification of renal allograft pathology. Transplantation 2018; 102: 1795-814.Matsuo S, Imai E, Horio M et al. Revised equations for estimated GFR from serum creatinine in Japan. Am. J. Kidney Dis. 2009; 53: 982-92.Dupont PJ, Psimenou E, Lord R, Buscombe JR, Hilson AJ, Sweny P. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or Vesicoureteric reflux. Transplantation 2007; 84: 351-5.Ransley PG, Risdon RA. The pathogenesis of reflux nephropathy. Contrib. Nephrol. 1979; 16: 90-7.Ransley PG, Risdon RA, Godley ML. High pressure sterile vesicoureteral reflux and renal scarring: an experimental study in the pig and minipig. Contrib. Nephrol. 1984; 39: 320-43.Coosemans W, Rega F, Roels L et al. Impact of early vesico ureteral reflux on the transplanted kidney. Transplant. Proc. 1999; 31: 362-4.