Outcomes after kidney transplantation in patients with urinary diversions or bladder augmentations: A 20-year nationwide study

Purpose: Patients with lower urinary tract diversions, either due to congenital malformations of the urinary tract and/or cancer, have a higher risk of chronic and end-stage kidney disease. Data on functional and surgical outcomes of kidney transplantation (KTx) in this patient population is limited. This study aims to evaluate post-transplant outcomes in patients with urinary diversions or bladder augmentations with over two decades of national data. Materials and Methods: This is a retrospective, national cohort study of KTx recipients transplanted between year 2000–2021, with documented prior urinary diversions or bladder augmentations. Short-and long-term complications were assessed and grad-ed using the Clavien–Dindo classification. Patient survival was analyzed using Kaplan–Meier estimates, and graft loss was evaluated using a competing risk time-dependent Cox regression model, with death as a competing event. Results: Twenty-five patients were identified and included, categorized as follows: Ileal conduit or continent cutaneous urinary diversion (n=9), Mitrofanoff with bladder augmentation (n=8), Mitrofanoff without bladder augmentation (n=6), and isolated bladder augmentation (n=2). Median age at transplantation was 28 years (interquartile range, 18–40). Short-term complications included urinary tract infection (UTI) (n=10), peri-graft fluid collection (n=7), bleeding (n=6), sepsis (n=4), and ureteral obstruction (n=4). Long-term complications included recurrent UTIs (n=18), graft-related abscess/infection (n=11), hydronephrosis (n=6), and ileus (n=4). Twenty-six grafts were included in the survival analysis. Ten-year patient and graft survival were 91.7% and 85.5%, re-spectively. Conclusions: KTx in patients with urinary diversions is rare. This study carefully suggests that these patients can be considered as candidates for KTx.