[Introduction] Post-transplant vesicoureteral reflux (VUR) is a complication of kidney transplantation (KT) causing graft interstitial fibrosis and tubular atrophy. However, risk factors for VUR or the effect on graft survival is unclear. Therefore, we retrospectively evaluated the association between VUR and graft survival.

[Methods] This study enrolled 354 consecutive KT recipients from 1996 to 2012, who all underwent ureteroneocystostomy (UCS). Mean age at KT was 41.9±13.8 years; dialysis period, 33.1±52.6 months. The presence of VUR was evaluated in 347 recipients using voiding cystourethrography performed routinely on day 4 post-KT, and when VUR was suspected based on frequent urinary tract infections, the existence of hydronephrosis, or medullary inflammatory cell infiltration on graft biopsy.

[Results] VUR was diagnosed in 55 cases (15.5%), at a median post-KT duration of 50.0 months (range: 0 to 172). Among VUR cases, 20 were observed, 17 underwent transurethral collagen injection, and 28 received UCS. Collagen injection failed in 13 of 17, leading to need for UCS. A Cox proportional hazards model was used to evaluate risk factors for VUR. Age under 60 years, hemodialysis period >10 years, deceased donor, and atrophic bladder (capacity ≤50 ml) were significantly associated with a higher risk of VUR on univariate analysis (risk ratio 3.24, 4.72, 3.30, 7.43; p=0.049, p<0.001, p=0.004, p<0.001, respectively). Atrophic bladder was the only significant factor associated with VUR on multivariate analysis (risk ratio 4.16; p=0.0117). KT recipients were divided into 2 groups, according to presence of VUR, and graft survival was compared. Five- and 10-year graft survival in recipients with VUR was 87.5% and 70.0%, and 92.0% and 82.8% in those without VUR, respectively. Graft survival rate in those with VUR was significantly lower than in those without VUR (p=0.0196).[Conclusion] Atrophic bladder causes post-KT VUR, and the presence of VUR is significantly associated with a lower long-term graft survival rate.

CITATION INFORMATION: Hirose T., Hotta K., Fukuzawa N., Mitsuke A., Harada H. Vesicoureteral Reflux after Kidney Transplantation Influences Long-Term Graft Survival Am J Transplant. 2017;17 (suppl 3).

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