Re: Renal Transplantation in Children Weighing <15 kg: Does Concomitant Lower Urinary Tract Dysfunction Influence the Outcome?

The most beneficial effects of renal transplantation (RTx) are observed in patients younger than 5 years and weighing less than 15 kg. However the subgroup of patients below 15 kg requiring RTx is a very unique group that has never been assessed previously regarding the role of concomitant lower urinary tract dysfunction (LUTD) in the success of RTx. The authors had retrospectively detailed the lower urinary tract management and compared outcomes in pediatric renal transplant (RTx) recipients weighing less than 15 kg, between 17 patients with LUTD and 51 without LUTD. While no lower urinary tract surgery had been required for the patients without LUTD, almost 50% of the patients with LUTD had required some form of lower urinary tract reconstruction and, in 30% a temporary incontinent urinary diversion had been placed at RTx since lower urinary tract function could not have been assessed reliably, the patients had not been collaborative enough to be involved in a voiding program and/or the need for proceeding with clinically too urgent RTx before accomplishing lower urinary tract reconstruction. Augmentation had been postponed until the graft function stabilized and also unnecessary hydrodistention have been avoided in case of a preRTx-accomplished augmentation in an anuric patient. No difference in patient survival, graft survival, and glomerular filtration rates between groups had been found. Authors conclude that concomitant LUTD does not adversely influence the outcome of RTx in patients who weigh less than 15 kg. However retrospective nature and limited number of patients are drawbacks of this stud