The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation (KTX) has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a risk factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations, and diagnostic methods of VUR after living donor kidney transplantation and their proper managements with the results of each treatment.
We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Voiding cystoureterography (VCUG) was performed as a confirmative study in patients with recurrent urinary tract infections and VUR was classified from Grade I to Grade IV. Twenty-three patients out of 34 patients who developed VUR after their KTXs underwent corrective surgical procedures, ureteroneocystostomy, but we excluded 3 patients who underwent the procedure less than 1 year and the other 3 patients with non-compliance during the study period. Study groups were divided into three: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of KTX patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI), graft function and survival rate were assessed for 1∼7years per each patient.
There were no significant demographic differences including immunological risk factors among study groups. There were 4 graft failures due to repeated UTIs in 2 patients and acute rejection in group I during the study period. In groups II and III, there were 1 and 4 graft failures due to acute rejection, respectively. Graft function was not different among 3 groups.
VUR did not seem to negatively affect graft function and survival if surgical correction was performed in proper time after the diagnosis. The indication of surgical correction of VUR is Grade III or IV VUR with clinically significant UTI and sepsis. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.