Extraperitoneal kidney transplantation: a comparison between children weighting ≤15 kg and &gt;15 kg. Experience of a single institution

Ghidini, Filippo; Corti, Federica De; Leon, Francesco Fascetti; Vidal, Enrico; Rancan, Alessandra; Parolin, Mattia; Zadra, Nicola; Grazzini, Maurizia; Antoniello, Luca Maria; Ganarin, Alba; Maita, Sonia; Tognon, Costanza; Mognato, Guendalina; Castagnetti, Marco; Benetti, Elisa; Gamba, Piergiorgio; Dall’Igna, Patrizia

doi:10.1111/tri.14015

Cited by 7 publications

(11 citation statements)

References 35 publications

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“…Finally, a total of 23 studies were included in this systematic review (Fig. 1) [9][10][11]12,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Search Resultsmentioning

confidence: 99%

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

Prudhomme¹,

Mesnard

Abbo

et al. 2023

Current Opinion in Organ Transplantation

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Purpose of review Kidney transplantation in low-weight recipients (<15 kg) is a challenging surgery with special characteristics. We proposed to perform a systematic review to determine the postoperative complication rate and the type of complications after kidney transplantation in low-weight recipients (<15 kg). The secondary objectives were to determine graft survival, functional outcomes, and patient survival after kidney transplantation in low-weight recipients. Methods A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline and Embase databases were searched to identify all studies reporting outcomes on kidney transplantation in low-weight recipients (<15 kg). Results A total of 1254 patients in 23 studies were included. The median postoperative complications rate was 20.0%, while 87.5% of those were major complications (Clavien ≥3). Further, urological and vascular complications rates were 6.3% (2.0–11.9) and 5.0% (3.0–10.0), whereas the rate of venous thrombosis ranged from 0 to 5.6%. Median 10-year graft and patient survival were 76 and 91.0%. Summary Kidney transplantation in low-weight recipients is a challenging procedure complicated by a high rate of morbidity. Finally, pediatric kidney transplantation should be performed in centers with expertise and multidisciplinary pediatric teams.

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“…Finally, a total of 23 studies were included in this systematic review (Fig. 1) [9][10][11]12,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Search Resultsmentioning

confidence: 99%

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

Prudhomme¹,

Mesnard

Abbo

et al. 2023

Current Opinion in Organ Transplantation

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“…Similarly, patient survival appeared to rapidly decline particularly in the <8.6 kg weight group in the immediate post‐transplant period. Several other single‐center studies have examined outcomes in children <15 kg 21–24 . Two studies comparing children <15 kg and those ≥15 kg showed that there was no difference in allograft outcomes based on weight at the time of transplant 22,24 .…”

Section: Discussionmentioning

confidence: 99%

“…Two studies comparing children <15 kg and those ≥15 kg showed that there was no difference in allograft outcomes based on weight at the time of transplant 22,24 . One study showed that recipients with a weight <15 kg at the time of transplant were associated with an increased occurrence of venous thrombosis 21 . A more recent larger study used the UK Transplant Registry and found significantly improved allograft survival over a 10‐year follow‐up period in children <15 kg at the time of transplant when compared to children ≥15 kg (85.4% vs. 73.5%; p = .002) 25 .…”

Section: Discussionmentioning

confidence: 99%

“…22,24 One study showed that recipients with a weight <15 kg at the time of transplant were associated with an increased occurrence of venous thrombosis. 21 A more recent larger study used the UK Transplant Registry and found significantly improved allograft survival over a 10-year follow-up period in children <15 kg at the time of transplant when compared to children ≥15 kg (85.4% vs. 73.5%; p = .002). 25 Our univariate analysis identified comparable outcomes in recipients weighing 8.6-9.9 kg at the time of transplant to higher weight groups, however, lower allograft and patient survival in recipients <8.6 kg at the time of transplant.…”

Section: Ta B L Ementioning

confidence: 99%

“…Several other single-center studies have examined outcomes in children <15 kg. [21][22][23][24] Two studies comparing children <15 kg and those ≥15 kg showed that there was no difference in allograft outcomes based on weight at the time of transplant. 22,24 One study showed that recipients with a weight <15 kg at the time of transplant were associated with an increased occurrence of venous thrombosis.…”

Section: Ta B L Ementioning

confidence: 99%

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Changes in graft outcomes in recipients <10 kg over 25 years of pediatric kidney transplantation in the United States

Kilduff,

Steinman,

Hayde

2023

Pediatric Transplantation

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BackgroundKidney transplant (KT) was initially associated with poor outcomes, especially in smaller recipients. However, pediatric transplantation has evolved considerably over time. We investigated the impact of weight at the time of transplant and whether outcomes changed over 25 years for <10 kg recipients.MethodsUsing the UNOS database, pediatric recipient outcomes were analyzed between 1/1/99 and 12/31/14. KT weight was stratified: <8.6 kg (mean weight of recipients <10 kg), 8.6–9.9 kg, 10–14.9 kg, 15–29.9 kg, and ≥30 kg. Outcomes in recipients <10 kg were then compared between 1990–1999 and 2000–2014.Results17 314 pediatric KT recipients were included; 518 (3%) had a transplant weight <10 kg. The highest rates of allograft loss and death were in recipients <8.6 kg and ≥30 kg. Recipients <8.6 kg also had higher rates of delayed graft function, rejection, and longer hospital length of stay. In the multivariable Cox regression model, transplant weight was not a predictor of allograft loss. When compared with recipients <8.6 kg, patient survival hazard ratios associated with recipient weight of 10–14.9 kg, 15–29.9 kg, and ≥30 kg were 0.61 (95%CI: 0.4, 1), 0.42 (95%CI: 0.3, 0.7) and 0.32 (95%CI: 0.2, 0.6), respectively. In the later era of transplant, recipients <10 kg had improved outcomes on univariate analysis; however, the era of transplantation was not an independent predictor of allograft loss or patient survival in Cox regression models.ConclusionsOutcomes in children weighing 8.6–9.9 kg at the time of KT were similar to higher weight groups and improved over time; however, special precautions should be taken for recipients <8.6 kg at the time of transplant.

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Pediatric kidney transplantation: is it safe to perform during night-time or day-off?

Ghidini,

Andreetta,

De Corti

et al. 2024

Pediatr Surg Int

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Purpose To investigate the impact of after-hours surgery on the outcomes of pediatric kidney transplantation (KT). Methods Medical records of pediatric KTs performed at a single institution between 2013 and 2021 were retrospectively reviewed. The population was split into three groups according to the incision time and calendar: ordinary day (8.00 AM – 6.30 PM), day-off, and night-time (6.30 PM – 8.00 AM). The following endpoints were compared: ischemia times, length of surgery, complications, delayed graft function (DGF), primary graft non-function (PGNF), and eGFR at three-month follow-up. Results Ninety-six non-living donor KTs were performed, median age 11 (IQR 4.3–14) years and median body weight 26 (IQR 13–50) kg. Forty-one (43%) were performed during night-time and 28 (29%) during day-off. Ischemia times were similar (p = 0.769, p = 0.536). Day-off KTs presented an extended length of surgery (p = 0.011). Thirty-two complications were reported in 31 KTs. No difference in the overall rate of complications, DGF, PNGF, and three-month eGFR was found (p = 0.669, p = 0.383, p = 0.949, p = 0.093). Post-operative bleedings were more common in days-off (p = 0.003). Conclusion The number of pediatric KTs performed during after-hours was considerable. Even though similar outcomes were reported, more caution should be focused on the KTs performed in days-off to avoid severe complications.

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Extraperitoneal kidney transplantation: a comparison between children weighting ≤15 kg and >15 kg. Experience of a single institution

Cited by 7 publications

References 35 publications

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

Changes in graft outcomes in recipients <10 kg over 25 years of pediatric kidney transplantation in the United States

Pediatric kidney transplantation: is it safe to perform during night-time or day-off?

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