Clinical significance of vesicoureteral reflux after kidney transplantation
Mastrosimone, S.; Pignata, G.; Maresca, M.C.; Calconi, G.; Rabassini, A.; Butini, R.; Fandella, A.; Di Falco, G.; Chiara, G.; Caldato, C.
Clinical Nephrology 40(1): 38-45
1993
ISSN/ISBN: 0301-0430 PMID: 8358874 Document Number: 413812
In this study 103 out of our 125 CsA-treated patients who received between January 1985 and December 1989 a first cadaver kidney transplant that functioned for at least one year were studied with voiding cystography (VC) for vesicoureteral reflux (VUR). All patients had an external uretero-neo-cystostomy. VUR occurred in 89 (86.4%) patients. Patients were grouped according to VUR: absence of VUR (group, 0), VUR grade I-II (group 1-2), and VUR grade III (group 3). The 3 groups were comparable for male/female ratio, cause of renal failure, cause of donor death, recipient and dialytic age, immunosuppressive therapy, follow-up, time of VC performance after transplantation. At 6 months and 1, 2, 3, 4, and 5 years after transplantation graft function, number of rejection episodes, and number of urinary tract infections (UTIs) were similar in the 3 groups. In groups 1-2 and 3 hypertension was more frequent than in group 0 and occurred even after the 6th month (whereas this did not happen in group 0), but the differences between the 3 groups were not significant. However, when only the 13 patients who were followed for 5 years were considered, the prevalence of hypertension after 5 years was significantly higher in groups 1-2 and 3 (both 100.0%) than in group 0 (33.3%) (chi-square = 7.88; p lt 0.02). Finally, 4.5% of patients with VUR and no patients without VUR had septic episodes linked to UTIs, but the difference was not significant. Our study shows that VUR does not harm grafted kidney function in the first 5 years following transplantation, although there are some indications suggesting that it may be a cause of slow-developing hypertension and septicemic episodes linked to UTIs.