Objective: The goal of this study was to evaluate pediatric post transplant vesicoureteral reflux 
(VUR) in terms of graft's Urinary Tract Infections (UTIs) episodes, graft outcome and survival in 
comparison to grafts that don't have reflux. Subjects and Methods: A total of 145 pediatric patients 
who underwent kidney transplantation at our transplantation unit between 2008 and January 2019 and 
suited our inclusion criteria were included in this retrospective cohort study and a voiding 
cystourethrography (VCUG) was done to them and categorized into main groups; group (A) refluxing 
graft group (n=66) and group (B) non refluxing graft group (n=79). Baseline donor and recipient 
demographic characteristics, post transplant serum creatinine level at different points, graft outcome, 
and UTIs were listed. Post transplantation (Tx) UTIs and graft outcome were compared between both 
groups. Glomerular Filtration Rate (GFR) was measured using Shwartz formula. Frequency- Volume 
Chart (FVC) and UroDynamic Study (UDS) were used to identify Lower urinary Tract (LUT) 
condition and helped us regarding decision making in management of graft VUR. Results: Mean ±SD 
age at time of Tx was 8.7±3.4y in group A versus 8.9±2.8y in group B, P value=0.667. Regarding sex, 
46 patients (69.7%) were male in group A, while 56(70.9%) were male in group B, p value = 0.876. 
UTI occurrence was similar between groups {40(60.6%) patients in group A versus 49 (62%) patients 
in group B, P value=0.861 but UTIs episodes (more than 3 episode per year) was 20 (30.3%) patients 
in group A versus 1(1.3%) patient, P value =0.001. Both groups were similar in terms of 5-year 
(100% versus 98.5%), and 10-year (76.2% versus 84.7%) graft survival. Conclusions: There was no 
difference between refluxing and non refluxing graft in terms of UTIs occurrence, graft function and 
survival. Frequency of UTI episodes was more in the refluxing graft like any native kidney primary 
VUR.