Scholarlink

Background <p>Posterior urethral valves (PUV) is a leading cause of childhood kidney failure requiring kidney transplantation (KT). Although graft survival in transplant patients with PUV has been reported to be similar to non-urologic etiologies of kidney failure, differences in long-term graft function and clinically meaningful kidney outcomes remain incompletely characterized. We compared post-KT progression to chronic kidney disease (CKD) in children transplanted for PUV versus non-urological conditions, exploring factors associated with faster decline.</p> Methods <p>A retrospective cohort study of pediatric KT recipients transplanted between 2000 and 2024 was conducted. Thirty-one patients with PUV were matched 1:1 by age at KT to males with non-urologic causes. Kidney function was assessed using estimated glomerular filtration rate (eGFR) at fixed time intervals. Time-to-event (TTE) analyses were performed for the development of CKD stage ≥ 3. Multivariable Cox proportional hazards regression evaluated factors associated with progression to CKD stage ≥ 3.</p> Results <p>Baseline demographic and KT characteristics, including rejection rates, were similar across groups. Patients with PUV had lower eGFR than controls at 1–10&#xa0;years after KT. Post-transplant urinary tract infections (UTI) were significantly more common in patients with PUV (68% vs. 3%, <i>p</i> &lt; 0.01). TTE analysis demonstrated earlier progression to CKD stage ≥ 3 among patients with PUV. In multivariable Cox regression, rejection was independently associated with progression to CKD stage ≥ 3 after adjusting for infections. Four graft losses occurred in the PUV cohort and none in the control cohort. Exclusion of graft losses did not alter TTE results.</p> Conclusions <p>Despite similar KT characteristics and rejection rates, children transplanted for PUV experience more infections and earlier deterioration of graft function and progression to CKD compared with children transplanted for non-urologic causes. These findings suggest the need for long-term, close monitoring and the proactive use of strategies to optimize bladder function in PUV KT recipients.</p> Graphical abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Post-transplant kidney function decline in children with posterior urethral valves versus non-urologic etiologies: roles of catheterization, infection, and rejection

  • 期刊论文

  • 发表日期：

    2026年5月30日

查看全文
  • Mandy Rickard,
  • Michael E. Chua,
  • Cal H. Robinson,
  • Nithiakishna Selvathesan,
  • Camila Morena Bencardino,
  • Jin Kyu Kim,
  • Adree Khondker,
  • Martina Bruniera,
  • Juliane Richter,
  • Ashlene McKay,
  • Joana Dos Santos,
  • Chia Wei Teoh,
  • Armando J. Lorenzo

摘要

Background

Posterior urethral valves (PUV) is a leading cause of childhood kidney failure requiring kidney transplantation (KT). Although graft survival in transplant patients with PUV has been reported to be similar to non-urologic etiologies of kidney failure, differences in long-term graft function and clinically meaningful kidney outcomes remain incompletely characterized. We compared post-KT progression to chronic kidney disease (CKD) in children transplanted for PUV versus non-urological conditions, exploring factors associated with faster decline.

Methods

A retrospective cohort study of pediatric KT recipients transplanted between 2000 and 2024 was conducted. Thirty-one patients with PUV were matched 1:1 by age at KT to males with non-urologic causes. Kidney function was assessed using estimated glomerular filtration rate (eGFR) at fixed time intervals. Time-to-event (TTE) analyses were performed for the development of CKD stage ≥ 3. Multivariable Cox proportional hazards regression evaluated factors associated with progression to CKD stage ≥ 3.

Results

Baseline demographic and KT characteristics, including rejection rates, were similar across groups. Patients with PUV had lower eGFR than controls at 1–10 years after KT. Post-transplant urinary tract infections (UTI) were significantly more common in patients with PUV (68% vs. 3%, p < 0.01). TTE analysis demonstrated earlier progression to CKD stage ≥ 3 among patients with PUV. In multivariable Cox regression, rejection was independently associated with progression to CKD stage ≥ 3 after adjusting for infections. Four graft losses occurred in the PUV cohort and none in the control cohort. Exclusion of graft losses did not alter TTE results.

Conclusions

Despite similar KT characteristics and rejection rates, children transplanted for PUV experience more infections and earlier deterioration of graft function and progression to CKD compared with children transplanted for non-urologic causes. These findings suggest the need for long-term, close monitoring and the proactive use of strategies to optimize bladder function in PUV KT recipients.

Graphical abstract