Efficacy and safety of subureteric injection in the management of vesicoureteral reflux in pediatric renal transplant recipients
A systematic review and meta-analysis
DOI:
https://doi.org/10.5489/cuaj.9704Keywords:
Pediatric kidney transplantation, vesicoureteral reflux, Deflux, subureteric injection, endoscopic treatment, systematic reviewAbstract
Introduction: Post-transplant vesicoureteral reflux (VUR) is a recognized complication in pediatric kidney transplant recipients. While subureteric injection is widely used as a minimally invasive treatment for primary VUR, its efficacy and safety in transplant-associated reflux remain unclear. We aimed to evaluate the effectiveness and safety of subureteric injection as first-line therapy for post-transplant VUR in pediatric renal transplant recipients through a systematic review and meta-analysis.
Methods: A comprehensive search of PubMed was conducted in January 2026 for studies published from 2000 onward. Eligible studies included pediatric patients (<18 years) with post-transplant VUR treated with subureteric injection as the initial therapy. Primary outcome was radiologic success (complete resolution or ≥1-grade improvement), and secondary outcomes included clinical success (resolution of febrile urinary tract infection [UTI]/pyelonephritis), ureteral obstruction, and need for redo ureteroneocystostomy (UNC). Pooled proportions were calculated using a random-effects model, and heterogeneity was assessed using I² statistics.
Results: Seven retrospective studies involving 69 pediatric patients (70 renal units) met the inclusion criteria. The pooled radiologic success rate was 36.3% (95% confidence interval [CI] 17.9–54.8), while clinical success reported in five studies was 51.0% (95% CI 8.1–94.0). Ureteral obstruction occurred in 3.8% of cases (95% CI -3.5–11.2). Rates of redo UNC varied widely across cohorts. Substantial heterogeneity was observed for both radiologic and clinical outcomes.
Conclusions: Subureteric injection may offer clinical benefit with a low complication profile in selected children with post-transplant VUR. Standardized, prospective multicenter studies are needed to clarify its role, identify optimal candidates, and guide escalation strategies.
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