ArticlePediatric nephrology (Berlin, Germany)2026
Post-transplant kidney function decline in children with posterior urethral valves versus non-urologic etiologies: roles of catheterization, infection, and rejection.
Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPosterior urethral valves (PUV) is a leading cause of childhood kidney failure requiring kidney transplantation (KT). Although graft survival in transplant patients with PUV has been reported to be similar to non-urologic etiologies of kidney failure, differences in long-term graft function and clinically meaningful kidney outcomes remain incompletely characterized. We compared post-KT progression to chronic kidney disease (CKD) in children transplanted for PUV versus non-urological conditions, exploring factors associated with faster decline.
methodsA retrospective cohort study of pediatric KT recipients transplanted between 2000 and 2024 was conducted. Thirty-one patients with PUV were matched 1:1 by age at KT to males with non-urologic causes. Kidney function was assessed using estimated glomerular filtration rate (eGFR) at fixed time intervals. Time-to-event (TTE) analyses were performed for the development of CKD stage ≥ 3. Multivariable Cox proportional hazards regression evaluated factors associated with progression to CKD stage ≥ 3.
resultsBaseline demographic and KT characteristics, including rejection rates, were similar across groups. Patients with PUV had lower eGFR than controls at 1-10 years after KT. Post-transplant urinary tract infections (UTI) were significantly more common in patients with PUV (68% vs. 3%, p < 0.01). TTE analysis demonstrated earlier progression to CKD stage ≥ 3 among patients with PUV. In multivariable Cox regression, rejection was independently associated with progression to CKD stage ≥ 3 after adjusting for infections. Four graft losses occurred in the PUV cohort and none in the control cohort. Exclusion of graft losses did not alter TTE results.
conclusionsDespite similar KT characteristics and rejection rates, children transplanted for PUV experience more infections and earlier deterioration of graft function and progression to CKD compared with children transplanted for non-urologic causes. These findings suggest the need for long-term, close monitoring and the proactive use of strategies to optimize bladder function in PUV KT recipients.
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