MP79-19 OUTCOME OF RENAL TRANSPLANT IN PEDIATRIC PATIENTS WITH OBSTRUCTIVE UROPATHY AND VOIDING DYSFUNCTION

INTRODUCTION AND OBJECTIVES: Patients with obstructive uropathy and voiding dysfunction (OUeVD), such as posterior urethral valves, neurogenic bladder dysfunction and vesicoureteral reflux represent 20% to 30% of kidney transplantation (KT) population. Historically, these patients were denied KT due to suboptimal lower urinary tract (LUT) and frequent UTI that may compromise graft survival. A number of series reported acceptable KT outcomes in these patients compared to patients with normal LUT. We aim to evaluate the outcome of KT in pediatric patients with ESRD due to OUeVD compared to patients with ESRD due to medical renal disease (MRD) METHODS: A retrospective review of patients’ records who underwent KT at Cairo University Pediatrics Hospital from January 2007 through January 2014. Outcomes of KT done for ESRD due OUeVD (Group I) were evaluated and compared with outcomes for KT done for ESRD due to MRD (Group II). Multiple perioperative parameters were examined including ancillary procedures performed to optimize the UT for KT in addition to graft survival. RESULTS: 103 patients underwent KT in the reviewed period with 74/103 (71.8%) males and 29/103 (28.2%) females. Mean patient age at KT was 5.05 12.4 (2.2e18) years. Group I patients included 29 patients while Group II included 74 patients. All patients in Group I needed ancillary procedure prior to KT with 55.2% in Group II. Mean follow up was 3.34 1.63 (1e7) years and 2.12 1.08 (1e5) years for Group I and II, respectively. Mean creatinine at 12 months was 0.94 0.24mg/dL and 0.97 0.36mg/dL for Group I and II respectively, with no statistically significant difference between the 2 groups (p1⁄40.8). All Group I patients were maintaned on TMPeSMX antibiotic prophylaxis. There was no signifant difference in posteKT UTI rates (7/29 (24%) in Group I and 9/74 (12.3%) in Group II (p1⁄40.05). The incidence of backepressure was comparable in both groups, 6/29 (20.69%) in Group I and 16/74 (21.62%) in Group II (P value1⁄40.92). CONCLUSIONS: KT can be safely performed in pediatric patients with OUeVD with/without reconstructed LUT, with results comparable to patients with ESRD due to MRD. Antibiotic prophylaxis helps maintain acceptable UTI rates.