Background/Objectives: Kidney transplantation is the treatment of choice for children with end-stage renal disease (ESRD), but its outcome can be affected by urological complications, with incidence rates of 2.5–25%. The aim of this study was to evaluate the occurrence of urological complications and their management in a cohort of pediatric kidney transplant recipients. Materials and Methods: A retrospective analysis on 178 patients who received a renal transplant at our Pediatric Kidney Transplant Center between 2011 and 2023 was conducted. Demographic and clinical data were analyzed. Urological complications were categorized as early, intermediate, or late based on their onset time. Results: Out of 178 patients, 28 (15.7%) experienced urological complications. Most patients (61%) had a pre-existing uropathy. Early complications (7–30 days) were all obstructive, namely, ureterovesical junction obstruction and perirenal collections. Intermediate complications (1–3 months) comprised ureteral stenosis, symptomatic vesicoureteral reflux (VUR), and obstructive lymphocele. Late complications (>3 months) included symptomatic VUR and ureteral stenosis, with one case leading to ureteral rupture. Early complications were often detected due to acute graft dysfunction, while late ones were mainly identified during routine clinical, laboratory, or ultrasound follow-up. Urological complications requiring surgical or endoscopic therapy were 13.4%. Most ureteral stenoses were treated with initial endoscopic stents, followed by definitive surgery. VUR was treated with endoscopic correction with a high success rate (75%), while open surgery was reserved for cases where initial treatments failed or complications recurred. No clear correlations were found between patient characteristics and risk of urological complication. Urological complications required multiple diagnostic procedures and therapeutic interventions (+2.5 admissions in mean and approximately +EUR 24,000) compared to an uncomplicated post-transplant course. However, they did not significantly impact transplant outcomes, with a graft survival rate comparable to that of the control group. Conclusions: Regular post-transplant follow-up is crucial, especially for patients with known risk factors, to allow for timely detection and treatment of urological complications, avoiding detrimental effects on graft function and improving transplantation outcomes.

Background and Objectives: Kidney transplantation is the preferred treatment for children with end-stage renal disease (ESRD), but its outcome can be affected by urological complications, with incidence rates of 1%-27%. The aim of this study was to evaluate the occurrence of urological complications and their management in a cohort of pediatric kidney transplant recipients. Materials and Methods: A retrospective analysis on 178 patients undergone to renal transplantation at our Pediatric Kidney Transplant Center between 2011 and 2023 was conducted. Demographic and clinical data were analyzed. Urological complications were categorized as early, intermediate, or late based on their onset time. Results: Out of 178 patients, 28 (15.7%) experienced urological complications. Most patients (61%) had a pre-existing uropathy. Early complications (7-30 days) were all obstructive, namely ureterovesical junction obstruction and perirenal collections. Intermediate complications (1-3 months) comprised ureteral stenosis, symptomatic vesicoureteral reflux (VUR), and obstructive lymphocele. Late complications (>3 months) included symptomatic VUR and ureteral stenosis, with one case leading to ureteral rupture. Early complications were often detected due to acute graft dysfunction, while late ones were mainly identified during routine clinical, laboratory, or ultrasound follow-up. Urological complications requiring surgical or endoscopic therapy were 13.4%. Most ureteral stenoses were treated with initial endoscopic stents, followed by definitive surgery. VUR was treated with endoscopic correction with a high success rate (75%), while open surgery was reserved for cases where initial treatments failed, or complications recurred. No clear correlations were found between patient characteristics and risk of urological complication. Urological complications required multiple diagnostic procedures and therapeutic interventions (+2.5 admissions in mean and approximately +24,000 euros) compared to an uncomplicated post-transplant course. However, they did not significantly impact transplant outcomes, with a graft survival rate comparable to the control group. Conclusions: Regular post-transplant follow-up is crucial, especially for patients with known risk factors, to allow timely detection and treatment of urological complications, avoiding detrimental effects on graft function and improving transplantation outcomes.

As the number of transplants and survival rates increase, concerns regarding the mental health of transplanted children and their correlated factors are growing. To assess the emotional, behavioral, and physical functioning of children who underwent various types of transplants, exploring its association with pet ownership. Pediatric transplant centers were contacted through the European Network “TransplantChild”. Primary caregivers were invited to complete an online survey including demographic information and the Strengths and Difficulties Questionnaire (SDQ). A total of 418 participants from nine European centers were included. The mean age of the children was 11.09 ± 4.17 years. Of these, 84% had undergone solid-organ transplantation and 16% had undergone hematopoietic stem cell transplantation; 43% of the children lived with dogs and/or cats. High rates of abnormal scores were observed across all the SDQ subscales, with peer problems being the most prevalent (29.8%). Solid-organ transplant recipients exhibited higher conduct-problem scores (p < 0.001). Older children had significantly higher scores on emotional and peer problems (p < 0.001). Pet ownership was associated with higher prosocial behavior scores (p < 0.05), even after adjusting for clinical severity. No statistically significant interaction effect was found between transplant type and pet ownership in any SDQ domain. Moreover, among patients aged >12 years, pet ownership was linked to fewer peer-relationship problems (p < 0.05). Transplanted children are at increased risk of emotional and behavioral difficulties. Pet ownership was associated with higher prosocial behavior and fewer peer problems in adolescents, supporting a potential beneficial role of companion animals in the psychosocial well-being of pediatric transplant recipients.