신이식 대상자의 방광요관역류가 술후 요로 감염 및 이식신 생존에 미치는 영향

Abstract

A policy concerning vesicoureteral reflux (VUR) in the renal transplantation candidate has been surgical correction or nephroureterectomy before renal transplantation because theoretically immunosuppression can favour the occurrence of urinary tract infection(UTI), pyelonephritis or bacteremia. Nevertheless, surgical procedures prior to transplantation are associated with considerable morbidity and majority of teams have adopted a more conservative approach. The post-transplantation urinary morbidity of reflux patients is not well known. From November 1982 to October 1992, 247 living renal transplantation were performed by our kidney transplantation team. Of 247 patients who obtained voiding cystourethrography before transplantation, 209 patients (84.6% ) were checked urinalysis, serum BUN/creatinine and graft status following surgery every a week. Native VUR was seen to occur in 24 of the 209( 11.5%). Acute pyelonephritis( 16.7% vs 8.6% ) and graft survival(29% vs 23%) were not correlated with the presence or absence of reflux. Regardless of reflux, most of UTI episodes(79 %), including, pyelonephritis and asymptomatic UTI, developed within the first year of surgery. In summary, pre-transplantation surgicalcorrection or nephroureterectomy should not be per formed routinely in VUR patients because of a little morbidity and similar incidence of UTI episodes to that of non-reflux patients. Close attention and prompt, specific treatment is necessary to minimize the adverse influence of UTI during the first year following renal transplantation. Key word : Vesicoureteral reflux, Native Kidney, Transplantation.