Effect of Extension in Submucosal Ureteral Tunnel to Prevent Vesicoureteral Reflux and Its Impact on the Graft Survival in Kidney Transplantation

T. Inoue,¹ S. Satoh,² M. Saito,¹ K. Numakura,¹ H. Tsuruta,¹ S. Akihama,¹ S. Narita,¹ N. Tsuchiya,¹ T. Habuchi.¹

¹Urology, Akita University, Akita, Japan
²Center for Kidney Disease, Akita University, Akita, Japan.

Meeting: 2015 American Transplant Congress

Abstract number: C220

Keywords: Kidney transplantation, Post-operative complications, Surgical complications

Session Information

Session Name: Poster Session C: Surgical Issues/Ureteral Complications

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Objects: It is plausible that vesicoureteral reflux (VUR) induced by an insufficient length of a submucosal ureteral tunnel leads graft function to deteriorate in kidney transplantation. We assessed the effect of extension in submucosal ureteral tunnel to prevent VUR in kidney transplantation and its impact of VUR on the graft function or survival.

Materials and Methods: From 1998 to 2012, a total of 207 patients who underwent kidney transplantation were evaluated in the single institute. Ureteroneocystostomy was extravesically performed using Lich-Gregoir method. The submucosal ureteral tunnel was created in a length of 2 cm on the first half of 101 patients, while in a length of 3 cm on the latter half of 101 patients. The patients underwent cystographies before and at one year post-transplantation to evaluate a bladder capacity and VUR to the graft.

Results: Prevalence of VUR in the 3 cm of submucosal tunnel group was significantly less than that in the 2 cm group (30.7% vs 16.9%, p = 0.022). The 2 cm of submucosal tunnel and a pretransplant bladder capacity less than 80 mL were the independent risk factors to predict VUR to the graft (p = 0.048 and p = 0.025, respectively).

Table 1: Univariate and multivariate analyses of risk factors to predict VUR to the graft at 1 year post-transplantation.
	Univariate analysis			Multivariate analysis (Stepwise)
	OR	p	95%CI	OR	p	95%CI
Age (> 50 vs < 50)	1.107	0.758	0.580-2.110	1.583	0.228	0.750-3.342
Sex (male vs female)	1.695	0.146	0.833-3.452
Use of Basiliximab (positive vs negative)	0.747	0.409	0.373-1.494
Use of Retuximab (positive vs negative)	0.631	0.310	0.260-1.533
Body Mass Index (> 22 vs <22)	1.195	0.592	0.623-2.295
Dialysis (HD or preemptive vs CAPD)	1.167	0.690	0.548-2.486
Dialysis duration (> 10 years vs < 10 years)	3.318	0.003	1.493-7.371
Submucosal ureteral tunnel (> 3cm vs < 3cm)	2.165	0.022	1.119-4.190	2.014	0.048	1.007-4.028
Pretransplant bladder capacity (< 80ml vs > 80ml)	2.825	0.003	1.414-5.644	2.291	0.025	1.109-4.731

VUR was not independent predictor of 24h creatinine clearance less than 60 mL/min at one year post-transplantation. VUR had no relationship with the poor graft survival.

Conclusions: Extension of the submucosal ureteral tunnel prevented VUR to the graft in kidney transplantation. However, VUR did not deteriorate the graft function and survival.

To cite this abstract in AMA style:

Inoue T, Satoh S, Saito M, Numakura K, Tsuruta H, Akihama S, Narita S, Tsuchiya N, Habuchi T. Effect of Extension in Submucosal Ureteral Tunnel to Prevent Vesicoureteral Reflux and Its Impact on the Graft Survival in Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-extension-in-submucosal-ureteral-tunnel-to-prevent-vesicoureteral-reflux-and-its-impact-on-the-graft-survival-in-kidney-transplantation/. Accessed May 18, 2025.

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