Transplantation direct
Renal Transplantation in Recipients With Modified Lower Urinary Tract: A Systematic Review and Implications for Adult Transplant Practice
By Sahni DS, Ahmad I, Kingsmore DB and 6 others.
Abstract
Background
Adults with a modified lower urinary tract (MLUT) represent a growing but understudied population in renal transplantation. Concerns regarding long-term graft survival, infection, and urological morbidity persist, yet adult-specific outcome synthesis and clinically useful guidance are lacking.
Methods
We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of studies reporting posttransplant outcomes in adults with abnormal or surgically MLUT anatomy. Primary outcomes were 1- and 5-y graft and patient survival. Secondary outcomes included urological complications. Given substantial heterogeneity, data were synthesized narratively.
Results
Twenty-four studies, including 511 MLUT recipients, were identified. Most were retrospective single-center series, and only a minority included comparator cohorts. Several studies included mixed adult-pediatric cohorts where adult-only outcomes could not be separated. Across comparative studies, 1-y graft survival appeared broadly similar between MLUT and control recipients, whereas 5-y graft survival was more often lower in MLUT cohorts. Patient survival was comparable, although long-term comparative data were limited. Urological morbidity was consistently greater in MLUT recipients, particularly recurrent urinary tract infection and the need for further urological intervention.