Revision Ureteroneocystostomy in Pediatric Renal Transplant Patients for Symptomatic Vesicoureteral Reflux and Its Effect on Recurrent Hospitalizations

P. Campbell¹, M. Christman¹, S. Marietti², E. Ingulli²

¹Naval Medical Center San Diego, San Diego, CA, ²UCSD Rady Children's Hospital, San Diego, CA

Meeting: 2022 American Transplant Congress

Abstract number: 837

Keywords: Infection, Kidney, Post-operative complications, Surgery

Topic: Clinical Science » Kidney » 43 - Kidney: Pediatrics

Session Information

Session Name: Kidney: Pediatrics

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: To evaluate the effect of revision ureteroneocystostomy on pediatric renal transplant patients with symptomatic vesicoureteral reflux (VUR) in reducing hospitalizations and recurrent urinary tract infections (UTI).

*Methods: We retrospectively reviewed pediatric patients from 2002 through 2021 who underwent renal transplantation at Rady Children’s Hospital and subsequently required revision ureteroneocystostomy due to symptomatic VUR. Symptomatic VUR was defined as recurrent culture positive UTI or pyelonephritis requiring antibiotic treatment. We analyzed the differences in days hospitalized, days hospitalized due to UTI, and treated UTI prior to and after revision ureteroneocystostomy.

*Results: A total of 189 transplantations were identified during the study period with 10 patients requiring revision ureteroneocystostomy secondary to symptomatic VUR. The median age at transplant and revision ureteroneocystostomy was 11.45(IQR 7.3-15.2) and 15.45(IQR 11.9-18.9) years respectively. Following revision, 0 patients had recurrence of their VUR on voiding cystourethrography. There was no difference in the observation time between transplant to revision, and revision to last follow up (2.3 years (IQR 1.3-6.5) vs 1.7 years (IQR 1-6.7), p=0.4446). Overall, there was a significant decrease in the total number of hospitalization days (21.5 (IQR 3-43) vs 5.5 (IQR 0-9), p=0.0058), total number of hospitalization days related to UTI (14.5 (IQR 3-28) vs 5.5 (IQR 0-9), p=0.0076) and total treated UTI (3.5 (IQR 3-6) vs 1 (IQR 0-2), p=0.0186) comparing pre-revision to post-revision patients. The rate of hospitalization days for UTI was also decreased following revision ureteroneocystostomy (7.15 (IQR 0.4-11.75) vs 0 (IQR 0-0.8), p=0.0076).

*Conclusions: Recurrent UTI in pediatric patients with VUR into their renal transplant can result in graft dysfunction or even loss, increased hospital cost, and impaired social and cognitive development in school-aged children due to time spent hospitalized. Revision ureteroneocystostomy can limit many of the negative consequences of recurrent graft infections and should be strongly considered in children with symptomatic VUR.

To cite this abstract in AMA style:

Campbell P, Christman M, Marietti S, Ingulli E. Revision Ureteroneocystostomy in Pediatric Renal Transplant Patients for Symptomatic Vesicoureteral Reflux and Its Effect on Recurrent Hospitalizations [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/revision-ureteroneocystostomy-in-pediatric-renal-transplant-patients-for-symptomatic-vesicoureteral-reflux-and-its-effect-on-recurrent-hospitalizations/. Accessed November 23, 2024.

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