Vesicoureteral reflux and urinary tract infections in renal transplant recipients
C. D. Hanevold, B. A. Kaiser, J. Palmer, M. S. Polinsky and H. J. Baluarte
Fifty-six children who received kidney transplants were evaluated for
postoperative vesicoureteral reflux and frequency of urinary tract
infection. Two methods of ureteral implantation were compared: a
nonantireflux extravesicular ureteroneocystostomy and an antireflux
intravesicular ureteroneocystostomy. Reflux was found in 79% of children
who had the nonantireflux procedure vs 19% of children who had the
antireflux procedure. This disparity was present regardless of sex and age.
Infections occurred at a rate of one per 11 patient-months after the
nonantireflux procedure vs one per 40 patient-months after the antireflux
procedure. Regardless of surgical technique, the incidence of infection was
higher in children with reflux. The potentially harmful effect of infection
with reflux warrants concern. Because of the need to maximize allograft
function for a longer time period, an antireflux procedure is recommended
in all pediatric kidney transplants.
