Simultaneous pediatric kidney transplantation and ureterocystoplasty in a 20-month-old boy


Ojogho N. Okechukwu, Associate Professor of Surgery, Director of the Transplantation Institute, Loma Linda University Medical Center, 11234 Anderson Street, Room 1405, PO Box 2000, Loma Linda, CA 92354, USA
Tel.: 909 558 1702
Fax: 909 558 0110


Abstract:  Kidney transplantation (KT) in children with end-stage renal disease and an abnormal bladder poses a complex management challenge. Ureterocystoplasty (UC) has been previously reported in older children with non-compliant bladders, but the timing and technique of repair are controversial. This case reports the youngest patient, a 20-month-old boy to undergo successful single-stage UC and living-related KT. UC was performed because of a fibrotic, non-compliant bladder. A temporary vesicostomy was placed to provide adequate drainage in the presence of urethral stenosis. The patient developed a single episode of pyelonephritis within the first six months post-operatively, but there were no other urologic complications. At 13 months, the renal function is excellent with a mean glomerular filtration rate of 100 mL/min/1.73 m2 and no clinical evidence of rejection. This case demonstrates that simultaneous UC and KT can be safely performed even in infants with non-compliant bladders and renal failure.