Abstract: FR-PO432
Incidence and Outcomes of Vesicoureteral Reflux After Pediatric Renal Transplant
Session Information
- Pediatric Nephrology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Alexander, Kelsi, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Bartosh, Sharon M., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Engen, Rachel M., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background
Vesicoureteral reflux (VUR) is a common complication following pediatric renal transplant. There is little data on the incidence of VUR or its effect on histologic graft changes or graft survival.
Methods
All pediatric renal transplant recipients from 2007-2020 underwent voiding cystourethrogram at 6 months post-transplant and protocol biopsy at 3 months and 12 months post-transplant. Lich-Gregoir anastomosis was used for 95% of patients. Patients were categorized based on VUR grade: no/low-grade VUR (grades 0-2) and high-grade VUR (grades 3-5). Outcomes included time to graft failure, change in eGFR, and Banff score on protocol biopsy.
Results
Of 67 renal transplant recipients, 35% had no VUR, 2% had grade 1 VUR, 21% had grade 2 VUR, 30% had grade 3 VUR, 11% had grade 4 VUR, and 2% had grade 5 VUR. When controlling for age, patients with high-grade VUR had increased risk of graft failure compared to patients with low-grade VUR (aHR 4.6 (95%CI 1.3-16.5) p=0.019)). Median decline in eGFR from 3 months to 5 years post-transplant was greater among those with high-grade VUR (-15.5 (IQR -19 to 16.7) ml/min/1.73m2) compared to those with no/low-grade VUR (0.55 (IQR -31.2 to -8.2) ml/min/1.73m2) (p=0.007). There was a trend toward more acute inflammation on protocol biopsy among those with high-grade VUR, as demonstrated by change in Banff t and i score, but this did not reach statistical significance.
Conclusion
Pediatric patients with high-grade VUR at 6-months post-renal transplant appear to have worse long-term graft function and increased risk of graft failure compared to patients with no or low-grade VUR. Larger studies are needed further characterize the relationship between VUR and graft outcomes.
Protocol biopsy Banff Scores