PEDIATRICS

G. Varela-fascinetto¹, A.L. Gonzalez-jorge¹, J.A. Hernandez-plata¹, E. Bracho-blanchet², B. Romero-navarro³, A.M. Raya-rivera⁴, A. Reyes-lopez^5
1Transplantation Department, HOSPITAL INFANTIL DE MEXICO FEDERICO GOMEZ, MEXICO CITY/MEXICO, ²Pediatric Surgery, HOSPITAL INFANTIL DE MEXICO FEDERICO GOMEZ, MEXICO CITY/MEXICO, ³Nephrology Department, HOSPITAL INFANTIL DE MEXICO FEDERICO GOMEZ, MEXICO CITY/MEXICO, ⁴Urology Department, HOSPITAL INFANTIL DE MEXICO FEDERICO GOMEZ, MEXICO CITY/MEXICO, ⁵Clinical Research Department, HOSPITAL INFANTIL DE MEXICO FEDERICO GOMEZ, MEXICO CITY/MEXICO

Body: Introduction: Anatomical and functionaldisorders of the lower urinary tract represent up to 40% of the causes of renal failure in children. Several centers avoid renal transplantation (RT) in these patients because of the high risk ofcomplications and lower graft survival. The aim of this work was to determine the frequency of urinary tract abnormalities (UTA) in our pediatric RT series, and compare the frequency ofcomplications, function and long term graft survival to patients with no UTA. Methods: This was a single center, retrospective, analytical and comparative study, between pediatric RTrecipients with UTA and those without them. Demographics, etiology, pre-transplant protocol, urinary tract rehabilitation, incidence of complications, rejection events and graft function and survivalwere analyzed.Central tendency and dispersion measures were used for the description of continuous variables. For qualitative variables,frequencies and proportions were used. In order toestablish any relation between two nominal qualitative variables, contingency tables were used and analyzed with Chi-Square Test or Fisher’s exact test in cases where samples were small in atleast one cell. To asses graft function, serum creatinine levels were compared by analysis of variance of repeated measurements with a fixed effect factor. Estimated risks were obtained by comparingboth groups with odds ratio. Actuarial graft and patient survival curves were constructed with Kaplan-Meier and comparedby log-Rank methods. SPSS version 15.0 was used for statistical analysis. Results: 328 pediatric RT were performed between1998 and 2008. Nine patients were excluded from the study due to incomplete medical records; 319 RT in 312 patients were analyzed. Sixty seven (21%) of these patients had UTA. The average age, weightand height at the time of RT were significantly lower in the urological group (11.1 vs. 12.6 yr, 28.8 vs. 34.4 kg; 125.4 vs. 138.4 cm). Transperitoneal approach and anastomoses to the vena cava andthe aorta showed significantly higher frequency in patients with UTA (p<0.001), posing a greater technical challenge in this population. No differences in creatinine levels at 6 months, 1, 2, 5and 10 years (Cr. 1.3 vs. 1.6 at 5 years and 1.4 vs. 1.5 at eight years) were found between groups. Urological complications, including urinary tract infections (UTI), occurred in 80.6% of thepatients with UTA versus 42.1% in the non-UTA group (p<0.001). UTI appeared predominantly in patients with UTA (62.7% vs. 35.5%, p<0.001), representing a 2.7 fold risk compared to thosetransplanted for other reasons. Rejection was similar in both groups (49.8%). There was no significant difference in 5-year (89.8 vs 85%) and 10-year (83 vs 67%) graft survival between groups(p=0.162). Conclusion: Our results demonstrate that with proper interdisciplinary care, graft and patient survival of pediatric RT recipients with UTA are not affected, and therefore; thesepatients should not be rejected for transplantation.

Disclosure: All authors have declared no conflicts of interest.