Renal Transplantation into Urinary Diversions and Reconstructed Bladders
BAUS ePoster online library. Chong J. Jun 25, 2019; 259573; P7-9
James Jen Yao Chong
James Jen Yao Chong
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Abstract
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Introduction:
Renal failure secondary to urological disorders can necessitate urinary diversion or reconstruction either pre or post-transplant (KT). Decision-making regarding timing of diversion/reconstruction may be affected by living (LD) or deceased (DD) donor options. We assessed KT outcomes into urinary diversions and reconstructed bladders.

Patients and Methods:

Single-centre retrospective review of 4679 KTs between 1986-2018. Graft and patient survival (GPS) were calculated.

Results:

54 patients (mean age 38) who had 63 transplants (1.3%) required urinary diversion or reconstruction; 5 had initial diversion and subsequent undiversion/reconstruction. Mean follow-up was 141months.

Cutaneous ureterostomy (CU): 12 patients (7 LD; 6 DD); 10 at transplant. 1 patient required two sequential transplants; first was diverted to CU 3 years after transplant (for unrecognised neuropathic bladder), the second a planned CU. The other CU was 4 years post-transplant for a radiotherapy vesico-vaginal fistula from cervical cancer.

Ileal Conduit (IC): 15 into pre-formed IC (7 LD; 8 DD). 7/15 died; 4/7 with functioning transplant.

Post-transplant IC: 5 transplants into bladder but subsequent IC diversion (4 due to bladder cancer and 1 due to worsening bladder function from spina bifida).

Reconstructed urinary tract: 20 transplants into augmented bladders using native ureter (2), gastric-segment (1), ileo-caecum (6) and ileum (16). 5 were augmented post-transplant; 2 were undiverted into neo-bladders post-transplant.

Conclusions:

Transplantation into urinary diversions and reconstructed bladders appears safe, with similar GPS to our general transplant population. DD kidney recipients with unsafe bladders may require initial CU before undiversion and reconstruction to prevent complications from a 'dry' augment.
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