LONG-TERM KIDNEY TRANSPLANTATION OUTCOMES IN PATIENTS WITH CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT – A RETROSPECTIVE ANALYSIS FROM TERTIARY CARE CENTRE IN SOUTH INDIA

Introduction:

Congenital anomalies of the kidneys and urinary tracts (CAKUT) are developmental embryonic disorders resulting in a spectrum of defects in the kidneys and outflow tracts which include the ureters, the bladder, and the urethra. Accelerated progression of CKD occurs with severe CAKUT. In LMICs like India, even though Deceased donor Renal Transplantation programmes are picking up, Live Renal Transplantation remains most common. People are so hesitant for live donation to this vulnerable children and young adults. Even though we see lot of CAKUT cases in Haemodialysis units, only very small subset of them undergo renal transplant. There is paucity of data in this domain in our country where there is no uniform CAKUT, CKD or transplant registry.

Aim:

To analyse long-term outcomes after kidney transplantation (KTx) in patients with congenital anomalies of the kidney and urinary tract (CAKUT)

Methods:

This is a single centre, Retrospective, observational study. KTx recipients (KTRs) with CAKUT in 2011–2023 were identified. The primary outcome was Graft survival. Graft loss was defined as reinitiation of dialysis or GFR <15 ml/min. Secondary outcomes included Patient survival, recurrent / complicated urinary tract infections (UTIs), urological complications, biopsy-proven acute rejections. Variables of interest were recipient age at time of transplant, sex, primary renal disease, donor type (living or deceased), donor age, time on dialysis, ischaemia time, delayed graft function (defined by use of dialysis in the first 7 days after transplant), CIC usage, cause of graft loss and death.

Results:

We identified 49 KTRs (male- 43, Female-6) with CAKUT (total 776 KTRs). Median age was 25.9 years (IQR: 18–29) and Median follow-up was 65 months. (IQR: 34.0–93.0) months. 26.5% of study population received deceased donor KT. 30.6% of study group had DGF. Reflux nephropathy (n=21), Congenital obstructing posterior urethral membranes(COPUM) (n=15), renal dysplasia/hypoplasia(n=4), Neurogenic bladder(n=2) were common etiologies. Death-censored 5 year graft survival was 79.5% (VUR 76.1%, PUV 73.3%). 3 patients expired with functioning graft due to infections (COVID 2, other pneumonia 1). Urological complications requiring intervention occurred in 10 patients(Urethral strictures 4, Ureteric obstruction 3, bladder retention 3). Recurrent UTIs and complicated Urinary tract infections were common in CAKUT patients 26.5% (graft survival group 15.3% vs graft loss group 66.6% ). 3 patients were on Clean-intermittent Catheterization(CIC). 2 patients had graft loss at 1 year and 52 months. Biopsy- proven acute cell-mediated and antibody mediated rejections occurred in 14 patients (28.5%)

Conclusions:

KTRs with CAKUT had overall good 5 year death censored graft survival and 5 year Patient survival. Urological complications, Being on CIC, Recurrent and Complicated UTIs were associated with early graft loss. Transplant centers should develop multidisciplinary educational and social working groups to support and encourage CAKUT patients with kidney failure to seek for transplants. Importance of electronic medical records/creation of CAKUT/uniform transplant registries need to be reemphasized in developing countries

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.