Evaluation of the therapeutic effect of pediatric kidney transplant recipients combined with bladder dysfunction

doi:10.3877/cma.j.issn.1674-3903.2025.01.001

Abstract

Abstract:

Objective

To evaluate the efficacy in pediatric kidney transplant recipients combined with bladder dysfunction.

Methods

Retroactively review the clinical data of pediatric recipients who underwent kidney transplantation operation at the Children's Hospital of Fudan University from December 1, 2022 to July 15th, 2024. Children with bladder dysfunction (neurogenic bladder and posterior urethral valve) were included in the case group (n=8), while those without bladder dysfunction were included in the control group (n=97). Collect data and compare the basic information, surgical and hospitalization duration, as well as the incidence of delayed graft function(DGF), acute rejection, urinary tract infection, hydronephrosis of the transplanted kidney, and ureterovesical anastomotic obstruction after transplantation between the two groups. The survival rates of the children and the transplanted kidneys were also compared. The preoperative bladder dysfunction and postoperative follow-up of the children in the case group were evaluated. The Mann-Whitney U test was used for inter group comparison of non-normal distribution quantitative data, and Fisher's exact probability method was used for inter group comparison of count data. P value ＜0.05 was considered statistically significant.

Results

Among the 8 cases in the case group, 3 cases were neurogenic bladder and 5 cases were posterior urethral valve. The average follow-up time for the case group and the control group until February 2025 was 417(291, 543) days and 434(295, 670) days, respectively.8 cases of pediatric patients and transplanted kidneys in the case group all survived； All 97 children in the control group survived, while 5 cases experienced loss of transplanted kidney function. There was no statistically significant difference in the survival rate of pediatric patients and transplanted kidneys between the case group and the control group (χ²=0.00 and 0.43, all P＞0.05). The incidence of postoperative urinary tract infection in the case group (6/8) was higher than that in the control group(8/97), and the difference was statistically significant (P＜0.001). None of the patients in the case group experienced surgical complications such as anastomotic obstruction after surgery, while the 4 patients in the control group underwent reoperation due to ureteral and bladder anastomotic obstruction after removing the double-J tube. There were no statistically significant difference in surgical duration,hospitalization duration, DGF and acute rejection of transplanted kidneys, transplanted kidney hydronephrosis, and reoperation for anastomotic obstruction between the case and the control groups (all P＞0.05).

Conclusions

The herapeutic effect in pediatric kidney transplant patients combined with bladder dysfunction is satisfactory, but the incidence of postoperative urinary tract infection is relatively high.

Key words: Pediatric kidney transplantation, Bladder dysfunction, Neurogenic bladder, Posterior urethral valve

Yubo Sun, Rui Chen, Yihui Zhai, Liangfeng Tang, Zhiqing Zhang, Chunyan Wang, Hongquan Geng, Qian Shen, Feng Liu, Hong Xu. Evaluation of the therapeutic effect of pediatric kidney transplant recipients combined with bladder dysfunction[J]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(01): 2-8.

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References 29

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组别	例数	年龄[d,M（P₂₅，P₇₅）]	性别(例,男/ 女)	尿量[mL/ d,M（P₂₅，P₇₅）]	透析(例,是/ 否)	血清肌酐[μmol/ L,M（P₂₅，P₇₅）]
病例组	8	4 891(3 408,5 540)	6/ 2	1 050(600,1 938)	5/ 3	531. 0(505. 5,631. 0)
对照组	97	3 844(2 911,4 802)	54/43	600(200,1 100)	75/22	637. 0(513. 0,902. 0)
Z值	-	1. 61	-	1. 93	-	-1. 18
P值	-	＞0. 05	0. 46^a	＞0. 05	0. 39^a	＞0. 05

组别	例数	年龄[d,M（P₂₅，P₇₅）]	性别(例,男/ 女)	尿量[mL/ d,M（P₂₅，P₇₅）]	透析(例,是/ 否)	血清肌酐[μmol/ L,M（P₂₅，P₇₅）]
病例组	8	4 891(3 408,5 540)	6/ 2	1 050(600,1 938)	5/ 3	531. 0(505. 5,631. 0)
对照组	97	3 844(2 911,4 802)	54/43	600(200,1 100)	75/22	637. 0(513. 0,902. 0)
Z值	-	1. 61	-	1. 93	-	-1. 18
P值	-	＞0. 05	0. 46^a	＞0. 05	0. 39^a	＞0. 05

组别	例数	手术时长[h,M（P₂₅，P₇₅）]	住院天数[d,M（P₂₅，P₇₅）]	移植肾功能延迟恢复(例)	急性排斥反应(例)	术后尿路感染(例)
病例组	8	2. 8(2. 4,4. 4)	18. 8(13. 4,50. 0)	2	1	6
对照组	97	2. 6(2. 3,2. 9)	19. 0(14. 5,30. 0)	15	4	8
Z值	-	1. 12	0. 05	-	-	-
P值	-	＞0. 05	＞0. 05	0. 61^a	0. 33^a	＜0. 001^a
组别	例数	拔除双J 管后移植肾积水(例)^b			输尿管膀胱吻合口梗阻再手术(例)
组别	例数	拔除后2 d	拔除后3 个月	拔除后6 个月	输尿管膀胱吻合口梗阻再手术(例)
病例组	8	2	2	1	0
对照组	97	35	11	9	4
Z值	-	-	-	-	-
P值	-	0. 71^a	0. 26^a	0. 56^a	1. 00^a

组别	例数	手术时长[h,M（P₂₅，P₇₅）]	住院天数[d,M（P₂₅，P₇₅）]	移植肾功能延迟恢复(例)	急性排斥反应(例)	术后尿路感染(例)
病例组	8	2. 8(2. 4,4. 4)	18. 8(13. 4,50. 0)	2	1	6
对照组	97	2. 6(2. 3,2. 9)	19. 0(14. 5,30. 0)	15	4	8
Z值	-	1. 12	0. 05	-	-	-
P值	-	＞0. 05	＞0. 05	0. 61^a	0. 33^a	＜0. 001^a
组别	例数	拔除双J 管后移植肾积水(例)^b			输尿管膀胱吻合口梗阻再手术(例)
组别	例数	拔除后2 d	拔除后3 个月	拔除后6 个月	输尿管膀胱吻合口梗阻再手术(例)
病例组	8	2	2	1	0
对照组	97	35	11	9	4
Z值	-	-	-	-	-
P值	-	0. 71^a	0. 26^a	0. 56^a	1. 00^a

病例	性别	年龄(d)	原发病	既往手术史	症状	既往尿路感染	尿控方式	VCUG	尿动力学检查
1	女	4 931	神经源性膀胱	骶尾部脂肪瘤切除术、栓系松解术	两便困难、反复尿路感染	有	CIC	膀胱毛糙,左1 级反流	容量246 mL,顺应性9. 8 cmH₂O
2	女	5 631	神经源性膀胱	脊髓脊膜膨出修补术、栓系松解术	两便失禁	无	CIC	膀胱不规则增厚,左4 级、右1 级反流	容量90 mL,顺应性2. 1 cmH₂O
3	男	4 584	后尿道瓣膜	后尿道瓣膜切开、输尿管再植术	尿路感染	有	自主排尿	膀胱、尿道形态失常,不光整	容量618 mL,顺应性＞20 cmH₂O
4	男	6 121	非神经源性神经源性膀胱	无	无	无	自主排尿	多发憩室、小梁形成	容量423 mL,顺应性＞20 cmH₂O,最大尿流率15 mL/ s
5	男	3 416	后尿道瓣膜	后尿道瓣膜切开术	排尿困难、反复尿路感染	有	CIC	膀胱毛糙,形态失常,多发憩室、尿道局部狭窄	容量146 mL,顺应性6. 7 cmH₂O,最大尿流率1 mL/ s,大量残余尿
6	男	2 279	后尿道瓣膜	后尿道瓣膜切开术、膀胱造口术、输尿管造口术	反复尿路感染	有	输尿管造口	膀胱造口,容量极小(15 mL),双侧1 级反流	未检查
7	男	5 267	后尿道瓣膜	后尿道瓣膜切开术	排尿滴沥、尿线细	有	自主排尿	膀胱毛糙, 双侧4 级反流	容量276 mL,顺应性＞20 cmH₂O,最大尿流率1 mL/ s,大量残余尿
8	男	4 851	后尿道瓣膜	后尿道瓣膜切开术、输尿管再植术	排尿困难、反复尿路感染	有	CIC	膀胱不规则,左侧4 级反流	容量350 mL,顺应性＞20 cmH₂O,最大尿流率5 mL/ s,大量残余尿

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