Outcomes of kidney-transplanted patients with history of intestinal reconstruction of the urinary tract

Juliette Gueguen; Marc-Olivier Timsit; Anne Scemla; Jean-Michel Boutin; Franck Bruyere; Hélène Longuet; Rebecca Sberro-Soussan; Christophe Legendre; Dany Anglicheau; Matthias Büchler

doi:10.1002/bco2.105

Outcomes of kidney-transplanted patients with history of intestinal reconstruction of the urinary tract

BJUI Compass. 2021 Sep 3;3(1):75-85. doi: 10.1002/bco2.105. eCollection 2022 Jan.

Authors

Juliette Gueguen^{1

2}, Marc-Olivier Timsit^{3

4}, Anne Scemla⁴, Jean-Michel Boutin⁵, Franck Bruyere^{2

5}, Hélène Longuet¹, Rebecca Sberro-Soussan⁴, Christophe Legendre⁴, Dany Anglicheau⁴, Matthias Büchler^{1

2}

Affiliations

¹ Department of Nephrology and Clinical Immunology Hospital of Tours Tours France.
² Transplantation, Immunologie, Inflammation (T2I) University of Tours Tours France.
³ Department of Urology and Renal Transplantation Georges Pompidou European Hospital, AP-HP Paris France.
⁴ Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France.
⁵ Department of Urology CHU de Tours Tours France.

Abstract

Background: Due to increased risk of pyelonephritis, patients with intestinal reconstruction of the lower urinary tract (IRLUT) have long been advised against kidney transplantation. The aim of this study was to compare the outcomes of transplantation between patients with IRLUT and patients with normal LUT (NLUT) using propensity score matching method.

Methods: The study included 23 kidney recipients with IRLUT matched to 46 kidney recipients with NLUT using known allograft survival and pyelonephritis risk factors as covariates. One-, 5-, and 10-year graft survival, pyelonephritis, and surgical complications occurrence and graft function were compared.

Results: One-, 5-, and 10-year graft survival were 96%, 91%, and 63% in the IRLUT group and 96%, 88%, and 70% in the NLUT group, respectively (p = 0.72). Patients with IRLUT had increased cumulative risk of pyelonephritis at 10 years (70% vs. 19%; log-rank < 0.01) without impacting graft function or rejection occurrence. There was no difference in overall surgical complication, but patients with IRLUT had more urological complications than patients with NLUT (62% vs. 28%; p < 0.01).

Conclusions: Our case-control study consolidates the results regarding the safety of transplantation in patients with IRLUT using a strong validated matching method and provides new insights regarding graft function, pyelonephritis, and surgical complications in this population.

Keywords: kidney allograft survival; kidney failure; kidney transplantation; surgical complications; urinary tract deviation; urinary tract dysfunctions; urinary tract malformation.