الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
ESKD is one of the global health problems with significant burden on the health care systems in both developed and developing countries. Renal transplant is the optimal treatment modality for ESKD, improving patient’s survival and quality of life, with less cost of treatment after the first year of transplantation. Abnormal LUT can contribute to the progression of ESKD in a significant proportion of patients, mainly in pediatric population. It is essential to identify the LUT abnormality prior to renal transplant to avoid the deleterious effect of abnormal LUT on the transplanted kidney, and the possible infectious complications which can be life threatening in the immunocompromised patients. Aim of the work: To report the outcome of renal transplant in patients with abnormal LUT, describe the urologic interventions needed before and after renal transplantation in patients with abnormal lower urinary tract, determine the rate of post-operative complications, including hospital admission with urinary tract infection, and to detect the impact of lower urinary tract dysfunction on the graft and patient’s survival. Patients and Methods: It is a retrospective study involving patients who underwent renal transplant in Mansoura Urology and Nephrology Center, between January 1976 and January 2016. Patients’ demographics, perioperative variables, postoperative complications, and follow up outcome were retrieved from the archived computer files. This involved an access granted to review patients’ admission notes, laboratory, radiological, and histopathological data. Results: The 30-day readmission rate in the abnormal LUT group was 31.3%, the need for multiple readmissions during the first year post renal transplant was observed in 28% of patients with abnormal LUT, both of these findings were significantly higher than the normal LUT group. The 5-year patient and graft survival in patients with abnormal LUT in our study were 93.7 and 88.4 respectively. These survival rates didn’t show significant difference from patients with no LUT abnormality. Conclusion: We have concluded that renal transplantation in patients with abnormal LUT is a surgical challenge that was encountered in 9.9% of our transplant population. Meticulous perioperative evaluation and optimization of the LUT is a must. Although it is technically feasible, It was associated with higher incidence of early re-admission post renal transplant, recurrent admissions in the first post-transplant year, and urologic infectious complications, Noteworthy, these complications did not affect the long-term patient or graft’s survival. The only LUT factor that adversely affected the survival was using an alternative to the native bladder to achieve the primary urinary continuity Recommendations: tailoring the urologic work-up for the transplant candidates according to the urologic history, and initiating a prospectively maintained database to evaluate the functional outcome of the renal transplant patients with abnormal LUT.