Introduction

The aim of this study was to assess the results of kidney transplant(KT) in patients with bladder augmentation (BA) and compare results between enterocistoplasty and ureterocistoplasty.

Methods

Betwenn 1988 and 2015, 64 patients with BA underwent KT ( 3 after KT), due to significant lower urinary tract dysfunction. . Ten second and 1 third KT were performed, comprising 75 KT in 64 patients The bowel segments used in the augmentation included ileum in 45(70.3%) patients, ileocecal in 3(4.7%) patients and sigmoid in 4(6.3%) patients. The ureter was used in 12 (18.8%) patients. Redo BA was performed in 4 patients after ureterocistoplasty (1 redo ureterocistoplasty, 3 redo ileocistoplasty); 2 redo BA were performed before the first KT. Mean age at first KT in Group 1(enterocistoplasty, n=48) and Group 2(ureterocistoplasty, n=12) was 24.28 and 15.06 years, respectively. Mean age at BA in Group 1 and 2 was 19.06 and 11.87 years, respectively. Redo KT was performed in 6 (11.3%) and 6 (50%) patients in Group 1 and 2, respectively. KT from deceased donor in Group 1 and 2 was 39.6% and 44.4%, respectively. KT from living donor in Group 1 and 2 was 60.4% and 55.6%, respectively.

Results

Mean follow-up after first BA was 188,8±118,9 (17-522) months and 140,5±71,5 (16-224) months in Group 1 and 2, respectively . In group 1, overall patient survival after 10 years was 78.78% and actuarial graft survival at 1,3,5,7 and 10 years was 94.3%,92.2%,83.1%,70.1 and 63.1%, respectively. In group 2, overall patient survival after 10 years was 90.9% and actuarial graft survival at 1,3,5,7 and 10 years was 88.5%,76.7%,76.7%,68.2 and 34.1%, respectively. Forty (83.3%) and 8(66.7%) patients in Group 1 and 2 were in clean intermittent catheterism (CIC), respectively. Symptomatic or febrile urinary tract infection occurred at least 1 episode in 81.3% and 83.3% in group 1 and 2, respectively.

Conclusions

Both enterocistoplasty and ureterocistoplasty are safe and effective methods of restoring lower urinary tract function in patients with end stage renal disease and a small, noncompliant bladder. CIC is safe in both groups. Graft survival rates are similar until 9 years, with a tendency of poor results after 10 years in ureterocistoplasty patients.

Funding

none