Endoscopic Treatment for Post-Transplant Vesicoureteral Reflux.

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.

journal_name

Transplant Proc

authors

Wang HH,Ding WF,Chu SH,Chiang YJ,Liu KL,Lin KJ,Lin CT,Wang TM

doi

10.1016/j.transproceed.2019.03.018

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1420-1423

issue

5

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(18)31838-4

journal_volume

51

pub_type

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