Renal transplantation in children with posterior uUrethral valves

The first description of posterior urethral valves (PUV) was made more than 80 years ago by Hugh Hampton Young and represents a spectrum of severity, ranging from disease incompatible with postnatal life to minimal symptoms that may not manifest until later in life.

Treatment of PUV remains a clinical challenge for urologists, requiring active management from infancy into adulthood to prevent progressive deterioration of both the upper and lower urinary tracts. The objective of this study from Spain was to analyze whether renal transplantation in children with PUV constitutes a special group with respect to groups with different etiologies of end-stage renal disease (ESRD).

Between 1979 and 2004, 22 renal transplantations were performed in 19 children with PUV. The median age at renal transplantation was 10 years (range: 1.3-17). Immunosuppression was provided by triple therapy and polyclonal/monoclonal antibodies. This group was compared with the two control groups: (1) glomerulopathy (n=62) and (2) pyelonephritis/dysplasia (n=42) without lower urinary tract disease, transplanted in the same period. Ten graft losses occurred in 22 transplants: 2 patients had thrombosis; 3 with acute rejection; 2 with chronic graft nephropathy; and 3 deaths in the 1st postoperative month. They did not find significant differences between the PUV patients and the control group in renal function or probability of graft or patient survival at 1, 5, and 10 years. They observed a greater risk of urological complications in patients with PUV.

The group concluded that renal transplantation with PUV constitutes a unique group due to the presenting young age and the need for careful and complex medico-surgical management. However, in their study the results achieved with transplantation were similar to those obtained in the remainder of their transplant population. Although they are more complex, we should be able to obtain similar results in regards to renal transplantation.

Written by Pasquale Casale, MD - UroToday

Pediatric Nephrology 21(4): 566 - 571, April 2006