Recoverability of Bladder Function in Patients With Defunctionalized Bladder and Live-Donor Kidney Transplantation.

Abstract

Background: The purpose of this article was to assess the recoverability of bladder, in a subset of patients with uremia, planned for live-donor kidney transplantation.

Methods: Patients referred to the Voiding Dysfunction Unit for evaluation, prior to transplantation, were included in this study during the period 2004 to 2008 in a single institution with a track record in live-donor transplantation. Defunctionalized bladder was defined as patients with complete anuria or oliguria for at least 6 months. All had stage 5 end-stage renal disease (ESRD) and were subjected to invasive urodynamics prior and 6 months after live-donor kidney transplantation. Outcome measurement and statistical method: improvement of urodynamic variables after transplantation was the principal outcome measure. Comparisons were made using the one-sample two-tailed t test. One way analysis of variance was used for comparison of continuous variables and Pearson's Correlation coefficient for studying the correlation between the duration of anuria and different continuous variables.

Results: Thirty-two patients were included in this study. The bladder underwent a significant decline of its capacity with defunctionalization with a mean cystometric capacity at baseline of 253 ± 171 mL that increased to 389 (P = .001), compliance increased from 26 to 33 (P = .001), filling pressure decreased by 12 cm H20 (P = .001) and free maximum flow rate (Q max) increased from 13 to 16 mL/s (P = .007). Detrusor overactivity decreased in prevalence (from 26 to 14 cases) and amplitude (from 21 to 12 cm H20). Our study lacks voiding cystometry variables as well as in having diverse causes for defunctionalization.

Conclusions: After transplantation, urodynamic parameters significantly improved. With caution, these defunctionalized bladders (DBs) could be utilized for live-donor transplants with favorable functional outcome.