Kidney Transplant Outcomes in Recipients With Congenital Anomalies of the Kidney and Urinary Tract: A Single-Center Propensity Score-Matched Study

Abstract Objective Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of kidney failure in children and young adults, but the extent to which persistent urinary tract abnormalities influence long-term kidney transplant outcomes remains uncertain. We aimed to compare graft, patient, infectious, and urological outcomes between kidney transplant recipients with CAKUT and propensity score-matched recipients with non-CAKUT causes of kidney failure. Materials & Methods We retrospectively evaluated kidney transplantations performed at a single center between January 2010 and August 2025. The primary outcome was death-censored graft failure; secondary outcomes included overall graft and patient survival, delayed graft function, biopsy-proven acute rejection, major surgical complications, symptomatic and recurrent urinary tract infection (UTI), graft pyelonephritis, and allograft function. Results Delayed graft function, acute rejection, and major surgical complication rates were similar between groups. Symptomatic UTI (27.5% vs 13.8%; p = 0.005) and recurrent UTI (12.3% vs 5.1%; p = 0.033) were more frequent in CAKUT recipients, whereas the difference in graft pyelonephritis did not reach statistical significance (10.9% vs 5.1%; p = 0.075). Ten-year death-censored graft survival was higher in the CAKUT group (88.3% vs 76.9%; log-rank p = 0.018), while overall graft survival (82.4% vs 73.8%; p = 0.071) and patient survival (93.5% vs 92.7%; p = 0.740) were not significantly different. CAKUT remained associated with a lower adjusted risk of death-censored graft failure (HR 0.55; 95% CI 0.29–0.99; p = 0.048). Conclusion Recipients with CAKUT experienced a greater burden of posttransplant UTI but achieved similar patient and overall graft survival and superior death-censored graft survival compared with matched non-CAKUT recipients, supporting kidney transplantation after individualized urological assessment and sustained lower urinary tract surveillance.