Presentation Authors: Sida Niu*, Connor Chestnut, Priya Padmanabhan, Kansas City, KS
Introduction: Renal transplant is the most desired and cost-effective therapy for patients with end stage renal disease. While a lower urinary tract cause of end-stage renal disease is not an absolute contraindication to renal transplantation, appropriate vesical storage and drainage is imperative for survival and function of the graft. Thus, careful identification of certain transplant patients for preoperative urodynamics (UDS) may prevent post-transplant urological complications and possible graft failure.
Methods: We retrospectively reviewed all patients who underwent a renal transplantation with subsequent UDS testing at our institution between January 2000 to October 2016. None of the patients had preoperative UDS. Twenty-eight patients were identified and 11 were excluded due to missing data. Information collected included demographics, past medical and surgical history, transplant indication, dialysis duration, pre-transplant urine output, reason for urological evaluation, and UDS results. Characteristics of these patients were analyzed to assess for trends that may predict post-transplant urological issues and graft compromise based on pre-transplant risk factors.
Results: The most common comorbidities in the cohort were hypertension (88%), diabetes mellitus (53%), coronary artery disease (41%). The most common indications for transplantation were diabetes mellitus (47%) followed by hypertension (41%). Six of the 17 patients (35%) had post-transplant urological issues resulting in potential compromise of their grafts. In order, the most common reasons for post-transplant urological evaluation in these six patients were urinary retention/incomplete emptying, recurrent urinary tract infections, elevated creatinine, and transplant hydronephrosis. Urodynamic findings in these patients revealed incomplete emptying or retention (67%), detrusor overactivity (67%), hypotonic bladder (33%), atonic bladder (33%), poor compliance (33%), and small capacity (33%).
Conclusions: Our findings suggest urological evaluation with urodynamic testing is underutilized in the diagnosis, treatment and optimization of pre-existing urological conditions in order to improve graft success and avoid unforeseen problems in the pre-transplant setting. Currently, there is no consensus in existing guidelines regarding which patients should have formal urological evaluation with urodynamics before undergoing transplantation. Additional efforts in this area is necessary to improve the overall success of renal transplantations.