Introduction

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

Methods

Between 1988 and 2015, 64 patients with BA (3 after KT) underwent kidney transplantation, due to significant lower urinary tract dysfunction. There were 40 males and 24 females. Ten second and 1 third KT were performed, comprising 75 KT in 64 patients. 44 were from living donor and 31 from deceased donor. Mean age at first KT was 22.54±15.09 (3-64) years and mean age at first bladder augmentation was 18.31 ± 13.83 (2-64) years. The etiology of bladder dysfunction was neurogenic bladder due to spina bifida (23 patients), posterior urethral valve (12 patients), vesico-urethral reflux (6 patients), tuberculosis (8 patients) and other causes (14 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 (1 ureterocistoplasty and 3 ileocistoplasty), all after ureterocistoplasty. In 2 patients, it was performed before the first kidney transplant.

Results

Mean follow-up after first BA was 172.47 ±112,07 (11-522) months. Overall patient survival was 77.6% and actuarial graft survival at 1,2,5,7,9 and 10 years was 92%, 87.6%, 81.2%, 67.8%, 65.7% and 53.9%, respectively. Surgical complications included 1 vesicocutaneous fistula and 1 stenosis of ureteral reimplant. 51(79.7%) patients were in clean intermittent catheterization. Symptomatic or febrile urinary tract infections (UTI) occurred at least 1 episode in 79.3% of patients. Ten (62.5%) patients died of unrelated cause and 6 (37.5%) patients died due to related causes. The main cause of graft loss was chronic allograft nephropaty in 21 (77.7%) patients.

Conclusions

Augmentation cystoplasty is a safe and effective treatment for lower urinary dysfunction. Patients must be followed up closely with special attention to UTIs. Survival graft after 10 years seems to similar to regular KT recipients.

Funding

None