Renal transplantation is the optimal treatment for children with ESRD. We undertook this study to establish the outcome of pediatric renal transplants in a resource-constrained environment in a developing country. A retrospective analysis on 90 pediatric renal transplants (age at transplant 2 rejection episodes (p = 0.05), while sepsis (p = 0.01) was the most important contributor to patient loss. Pediatric renal transplantation in India can be accomplished successfully. The graft and patient survival in our study, the largest from India, is comparable to those published from developed countries and is encouraging given the limited resources.

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We encountered and reported a case of inadvertent misplacement of a tunneled hemodialysis catheter (tHDC) into azygos arch inserted form right internal jugular vein (RIJV) despite real-time fluoroscopy guidance. We subsequently performed a literature search of Pubmed using the index words of azygos, catheter, hemodialysis, misplace, malposition, and misposition, to study the anatomical and related factors predisposing unintended AV misposition in HD setting. The search was limited to reports in humans and with abstract in English. Results: From 2005 to August 31st, 2018, a total of 11 articles containing 16 cases of misplacement of HDCs into AV were identified. Of the 17 cases of unintentional AV misposition including our presented case, the majority of the HDCs (94.1%, 16/17) were tHDCs and only 1 case was with temporary (untunneled) catheter. Most catheter misplacements (88.2%, 15/17) were performed without real-time radiological guidance. The incidence of inadvertent AV cannulation in different institutions ranged between 0.6 to 3.8%. Among 16 misplaced tHDCs, the incidence rate of AV misposition from RIJV and left internal jugular vein (LIJV) was equally 50%. Conclusions: We present in this article probably the largest case series of HDC misplacement into AV. Based upon anatomical and case studies,we have verified that the vena azygos major joins the posterior aspect of SVC at different directions and levels. Despite relative low incidence, LIJV and RIJV insertion are both susceptible to this complication with a comparable incidence rate. Aside from anatomy, the material and gauge of the catheter,availability of radiological guidance and operator's experience all affect the outcome of CVC placement. Caution is advised to avoid likely pitfalls during HDC placement.

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