Identifying the role of pre-transplant urologic evaluation in children
Sahar Eftekharzadeh, MD, MPH, Benjamin L. Laskin, MD, MS, Sonya Lopez, RN, MSN, CRNP, Aznive Aghababian, BS, Dawud Hamdan, BS, Sandra Amaral, MD, MHS, Dana A. Weiss, MD.
The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background:Kidney transplantation is the treatment of choice for children with end-stage kidney disease (ESKD). Transplant success is dependent on a functional and low-pressure reservoir to hold and eliminate urine, limiting the risk of urinary tract infection and transmission of high pressures to the allograft. Congenital anomalies of the kidney and urinary tract (CAKUT) are the primary cause of ESKD in children. Children without CAKUT may also be at risk for bladder dysfunction post-transplant. However, there is no consensus on the need for pre-transplant urology evaluation in children without known lower urinary tract abnormalities. We hypothesized that a subset of these children would benefit from a pre-transplant urologic evaluation to identify and treat voiding dysfunction which may adversely affect post-transplant outcomes. Methods: We retrospectively identified all children who underwent kidney transplantation at our institution from 2009-2019. We excluded patients who had their initial transplant performed at an outside institution. Electronic health records were queried to obtain baseline demographics, etiology of ESKD, operative details, pre-and post-transplant urology consultation, and laboratory studies. Results:Of the 166 children who underwent initial kidney transplant at our institution, 129 (78%) met inclusion criteria (Table 1). Of this cohort, 92 (71%) did not have any urology consult pre-transplant, while 37 (29%) did. Ten of the 37 pre-transplant consults (27%) were pre-transplant evaluations, while 27 (73%) were patients who were previously followed by urology for other reasons. Out of the 92 who had never been seen by urology pre-transplant, 20 (22%) had a post-transplant consult for reasons including febrile UTI (13), urinary retention (2), nocturnal enuresis (3), urinary incontinence (2), and hydrocele unrelated to the transplant (1). Only 1 of the 13 seen for UTI had a history of UTI prior to transplant, and 1 of the 2 children seen for urinary retention had a history of retention in the past. Conclusion: Pre-transplant urologic evaluation can play an important role in identifying children at risk for urologic complications post-transplant. Understanding the reasons that children see urology pre and post-transplant, and the evaluations that they undergo, may identify screening questions for nephrologists in order to identify who may benefit from evaluation. 
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