MP72-12 OUTCOMES OF KIDNEY TRANSPLANT RECIPIENTS WITH BLADDER DYSFUNCTION AND BLADDER SUBSTITUTION

INTRODUCTION AND OBJECTIVES: A substantial proportion of kidney transplantation recipients have bladder dysfunction or have had bladder substitutions. We compared graft survival and post operative morbidity of these recipients after transplant to recipients with normal bladder function. METHODS: Electronic records of 1,753 patients who received a kidney-alone transplant at a single center between January 2000 and December 2008 were reviewed. Among these patients, 1652 were identified with normal bladder function, 80 with bladder dysfunction (defined as any disorder of urinary storage or emptying), and 21 with a bladder substitute (enterocystoplasty, continent pouch, orthotopic bladder substitution, ileal or colon conduit). Kaplan-Meier curves were generation that compared transplant kidney survival between groups. Multivariable regression modeling was also performed to identify variables associated with graft survival. RESULTS: Graft survival at 1 and 5 years was 93% and 77% for normal bladder function; 86% and 67% for bladder substitute; and 95% and 86.3% for bladder dysfunction (p 1⁄4 0.17). Patient survival at 1 and 5 years was 96% and 84% for normal bladder function; 91% and 75% for bladder substitute; and 96% and 90% for bladder dysfunction. Multivariate analysis demonstrated a trend toward inferior graft survival in recipients with bladder substitute (HR 1.9, 95% CI 0.88-4.09, p 1⁄40.09) but not bladder dysfunction. In normally functioning bladders, the most common cause of graft failure was chronic rejection (17%); in the bladder dysfunction and bladder substitute groups the most common cause of graft failure was infection (21%, 29%). Recipients with bladder dysfunction (OR: 3.65, p1⁄4.07) or bladder substitutes (OR: 7.47, p1⁄4.13) demonstrated a trend toward more post operative urinary tract infections and surgical complications, compared to normal bladder function. CONCLUSIONS: There was a trend toward decreased kidney graft survival in recipients with bladder substitution. Recipients with bladder dysfunction or substitution had a higher percentage of graft failure from infection and were more likely to have post operative urinary tract infections or surgical complications.