Congenital anomalies of the kidney and urinary tract(CAKUT) patients with renal transplants have better graft function and survival
Laura B. Cornwell, MD1, Jonathan V. Riddell, MD2.
1Rady Children's Hospital, San Diego, CA, USA, 2SUNY Upstate Medical University, Syracuse, NY, USA.
BACKGROUND: Patients with end stage renal disease (ESRD) secondary to congenital anomalies of the kidney and urinary tract (CAKUT) pose unique challenges in their management after renal transplantations. Patients with both lower urinary tract malformations (LUTM) and upper urinary tract malformations (UUTM) have been shown to have more frequent urinary tract infections after transplantation. However, no significant difference has been described in graft survival. We sought to identify trends in graft outcomes for patients in the United States with CAKUT who underwent renal transplantation.
METHODS: The United States Renal Data System (USRDS) is a national data system that collects information about chronic kidney disease, ESRD, as well as renal transplantation. The system has required enrollment of all ESRD patients since 1995. In collaboration with the Organ Procurement and Transplantation Network (OPTN), the system has also been collecting transplant and transplant follow up data. 324,087 individual patients who underwent renal transplant between 1995 and 2018 had follow up data available for review. We examined trends in the transplants, as well as outcomes for patients after transplant and compared CAKUT patients to their non-CAKUT counterparts.
RESULTS: 3,614 had a primary cause attributed to an UUTM (3,178 vesicoureteral reflux), and 463 patients had a primary cause of renal failure attributed to a LUTM. Of all patients reviewed, the latest available follow up for review was a mean 74.5 ± 57.3 months. Table 1 summarizes the comparisons between the groups. 5,201 patients (1.6%) had a reported graft failure, at a mean time of 12.4 months (± 30.4) post-transplant. Comparing the overall population to the CAKUT groups, patients with GU diagnoses were significantly younger at transplant and were more likely to recent live donor transplant. The mean creatinine at follow up was lower in the CAKUT groups and hospitalizations were less common in the UUTM patients but more common in the LUTM patients. Graft failure was less common in both CAKUT groups, with only 1 graft failure described in the LUTM (0.2%) and 40 in the UUTM group (1.1%). Of those with failure, the reason for rejection and time to rejection did not significantly vary between the groups. CONCLUSIONS: CAKUT patients who undergo renal transplantation have relatively good graft function and outcomes despite known higher rates of urinary tract infections. The relationship between infection and graft health, as well as who would benefit most from intervention needs to be further elucidated.
| All patients | UUTM | LUTM | p value | |
| N | 324,087 | 3,178 | 463 | - |
| age (yr) | 48 ± 15.3 | 36 ± 16.1 | 16 ± 12.5 | <0.001 |
| sex (% male) | 60.5% | 43.6% | 96.5% | <0.001 |
| live donor (%) | 35.3% | 48.3% | 47.5% | <0.001 |
| follow up (mo) | 74.5 ± 57.3 | 90 ± 62.6 | 69.4 ± 61.2 | <.0.001 |
| Cr @ follow up | 1.77 ± 1.18 | 1.69 ± 1.15 | 1.53 ± 1.26 | <0.001 |
| interval hospitalization (%) | 14.1% | 10.6% | 21.6% | <0.001 |
| graft failure (%) | 1.6% | 1.1% | 0.2% | <0.001 |
| time to failure (mo) | 12.4 ± 30.4 | 11.8 ± 29.0 | - | 0.912 |
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