Prevention of complicated UTIs with biocompatible hyaluronic acid copolymer (deflux®) treatment of the kidney transplanted vescicoureteral reflux. a single centre experience

Introduction: Urinary tract infections (UTI) are the most frequent early and late infectious complications in renal transplant patients. Vesicoureteral reflux (VUR) occurs in more than 86% of renal transplants. It is considered as a possible cause of the onset of complicated urinary tract infections although its actual impact remains uncertain. A therapeutic option in the treatment of VUR, successfully used in particular in pediatric patients, is represented by the injection in the ureter of hyaluronic acid/dextranomer polymers (Dx/HA, Deflux®) performed through the endoscopy procedure. In this study the experience of the Nephrology Unit at the University of Padova is reported. Methods: Six renal transplanted female patients (mean age 45.6 years) who presented a history of recurrent complicated UTIs (more than 3/year), were considered. In these patients a retrograde and voiding cystography documented the presence of VUR at the transplanted kidney. Between February 2016 and July 2018 all these patients underwent endoscopic treatment with Dx/HA. Results: Five patients, after endoscopic treatment with Dx/HA, did not show at the follow up until present any episode of complicated UTIs, confirming the successful of this therapeutic option for the UTI due to VUR in renal transplanted patients. Conclusions: Although based on a limited number of patients, the endoscopic treatment of VUR with hyaluronic acid copolymer Deflux® in kidney transplanted patients is safe, non-invasive, repeatable if necessary, and the results in our patients are favorable. Although considering a period of observation of two years, it might be too short to demonstrate the effectiveness of the treatment in the long-term. However, being able to successfully correct the VUR in kidney transplanted patients represents a very important chance to reduce complicated UTIs in kidney transplanted patients thus increasing the chance for the transplanted organ’s survival.