Endoscopic Treatment for Post-Transplant Vesicoureteral Reflux

Transplant Proc. 2019 Jun;51(5):1420-1423. doi: 10.1016/j.transproceed.2019.03.018. Epub 2019 May 7.

Abstract

Introduction: Vesicoureteral reflux (VUR) is one of the most common ureteric complications after kidney transplantation that might cause symptomatic infections which deteriorate graft function. Surgical reimplantation has been the standard treatment; recently, endoscopic injection has been an alternative approach. We report our endoscopic treatment results and analyze the long-term outcome, even in patients with less optimal graft function.

Materials and methods: A total of 16 patients and 19 symptomatic VUR were diagnosed at mean time of 88.3 months after their transplantation. The distribution of VUR grade was 1, 2, 8, 6, and 2 for grade I to V, respectively, with a mean VUR grade of 3.26 according to their voiding cystourethrogram images. Endoscopic Deflux injections were performed by a single urologist via rigid cystoscope with a beveled needle system. They were followed monthly thereafter.

Result: The average number of admissions due to symptomatic urinary tract infection was 2.68/person, and the mean creatinine level before endoscopic treatment was 1.63 mg/dL. The amount of Deflux injection was 0.7 to 1.2 mL per affected ureter; the mean creatinine level after endoscopic treatment was 1.41 mg/dL. The eGFR remained stationary in both eGFR > 60 and eGFR < 60 mL/min groups with a clinical success rate of 75% in both groups.

Conclusion: Endoscopic dextranomer-hyaluronic acid injection is a safe and feasible treatment option for VUR after kidney transplantation. Our data showed its efficacy in recipients whose eGFR is less than 60 mL/min.

MeSH terms

  • Child
  • Child, Preschool
  • Cystoscopy / methods*
  • Dextrans / therapeutic use*
  • Female
  • Humans
  • Hyaluronic Acid / therapeutic use*
  • Kidney Transplantation / adverse effects*
  • Male
  • Postoperative Complications / surgery*
  • Retrospective Studies
  • Treatment Outcome
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / surgery
  • Vesico-Ureteral Reflux / etiology
  • Vesico-Ureteral Reflux / surgery*

Substances

  • Dextrans
  • deflux
  • Hyaluronic Acid