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Allograft Vesicoureteral Reflux after Kidney Transplantation

Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized a...

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Autores principales: Brescacin, Alessandra, Iesari, Samuele, Guzzo, Sonia, Alfieri, Carlo Maria, Darisi, Ruggero, Perego, Marta, Puliatti, Carmelo, Ferraresso, Mariano, Favi, Evaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780114/
https://www.ncbi.nlm.nih.gov/pubmed/35056389
http://dx.doi.org/10.3390/medicina58010081
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author Brescacin, Alessandra
Iesari, Samuele
Guzzo, Sonia
Alfieri, Carlo Maria
Darisi, Ruggero
Perego, Marta
Puliatti, Carmelo
Ferraresso, Mariano
Favi, Evaldo
author_facet Brescacin, Alessandra
Iesari, Samuele
Guzzo, Sonia
Alfieri, Carlo Maria
Darisi, Ruggero
Perego, Marta
Puliatti, Carmelo
Ferraresso, Mariano
Favi, Evaldo
author_sort Brescacin, Alessandra
collection PubMed
description Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.
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spelling pubmed-87801142022-01-22 Allograft Vesicoureteral Reflux after Kidney Transplantation Brescacin, Alessandra Iesari, Samuele Guzzo, Sonia Alfieri, Carlo Maria Darisi, Ruggero Perego, Marta Puliatti, Carmelo Ferraresso, Mariano Favi, Evaldo Medicina (Kaunas) Review Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues. MDPI 2022-01-05 /pmc/articles/PMC8780114/ /pubmed/35056389 http://dx.doi.org/10.3390/medicina58010081 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Brescacin, Alessandra
Iesari, Samuele
Guzzo, Sonia
Alfieri, Carlo Maria
Darisi, Ruggero
Perego, Marta
Puliatti, Carmelo
Ferraresso, Mariano
Favi, Evaldo
Allograft Vesicoureteral Reflux after Kidney Transplantation
title Allograft Vesicoureteral Reflux after Kidney Transplantation
title_full Allograft Vesicoureteral Reflux after Kidney Transplantation
title_fullStr Allograft Vesicoureteral Reflux after Kidney Transplantation
title_full_unstemmed Allograft Vesicoureteral Reflux after Kidney Transplantation
title_short Allograft Vesicoureteral Reflux after Kidney Transplantation
title_sort allograft vesicoureteral reflux after kidney transplantation
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780114/
https://www.ncbi.nlm.nih.gov/pubmed/35056389
http://dx.doi.org/10.3390/medicina58010081
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