Long-term outcomes of living-donor kidney transplant children weighing less than 15 kg: Comparison of the surgical approach

Aoki, Yujiro; Satoh, Hiroyuki; Sato, Atsuko; Morizawa, Yosuke; Hamada, Riku; Harada, Ryuichi; Muramatsu, Masaki; Hamasaki, Yuko; Shishido, Seiichiro; Sakai, Ken

doi:10.1016/j.jpurol.2021.05.021

Cited by 5 publications

(7 citation statements)

References 22 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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“…The spectrum of nonrejection histopathologic changes in kidney allografts is a testament to the improvements in human leukocyte antigen (HLA) identification techniques and immunosuppressive therapies available to patients [1]. Additionally, advancements in surgical techniques have led to more creative and complex donor-recipient situations [2][3][4][5]. These situations are most pronounced among pediatric populations, both as donors and recipients.…”

Section: Introductionmentioning

confidence: 99%

Novel Histopathologic and Ultrastructural Findings in Renal Allografts From Patients With Size and Age Mismatches: A Case Series

Lilley¹,

Picken²

2023

Cureus

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While reports on the long-term pathology in mismatched allografts have been focused on the donor and recipient body surface area, evidence is emerging to support donor-recipient age difference as an additional prognostic factor. Most reports are based on pediatric recipients receiving older/bigger allografts. Here, we describe three cases with age mismatch including two cases of adult patients receiving pediatric allografts and a third case of a younger patient receiving an allograft from an older donor exhibiting findings not described in extant literature. Each of these cases exhibits unique changes seen in mismatched donorrecipient size/age post-transplant pathology. These non-rejection changes should be suspected in cases of donor-recipient size/age mismatch. In cases of allograft function decline, a full biopsy workup, including electron microscopy, should be considered.

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“…Many of our patients have urinary diversions that are more accessible from an intraperitoneal approach, which also leaves the iliac vessels available for anastomosis for future re‐transplant, as pediatric patients often require multiple transplants in a lifetime 18 . Ultimately, the approach for kidney transplantation is up to the surgeon’s discretion with consideration of the recipient’s needs 16,18 …”

Section: Introductionmentioning

confidence: 99%

“…14,15 When possible, the extraperitoneal approach is preferred as it decreases the risk for peritoneal disruption, avoids previous intraabdominal adhesions and the formation of new ones, while decreasing the risk of a prolonged post-operative ileus. 16,17 However, in our small patients, the intra-abdominal approach provides the necessary inflow and outflow pressures to accommodate the adult donor graft as well as allows for larger capacity to prevent compression of the allograft, theoretically improving patency of the allograft vasculature, which is widely reported in pediatric patients. 18 Many of our patients have urinary diversions that are more accessible from an intraperitoneal approach, which also leaves the iliac vessels available for anastomosis for future re-transplant, as pediatric patients often require multiple transplants in a lifetime.…”

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confidence: 99%

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Good outcomes after pediatric intraperitoneal kidney transplant

Gerzina

Brewer

Guhan

et al. 2022

Pediatric Transplantation

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Background: Kidney transplantation in small children is technically challenging.Consideration of whether to use intraperitoneal versus extraperitoneal placement of the graft depends on patient size, clinical history, anatomy, and surgical preference.We report a large single-center experience of intraperitoneal kidney transplantation and their outcomes. Methods:We conducted a retrospective review of pediatric patients who underwent kidney transplantation from April 2011 to March 2018 at a single large volume center.We identified those with intraperitoneal placement and assessed their outcomes, including graft and patient survival, rejection episodes, and surgical or non-surgical complications.Results: Forty-six of 168 pediatric kidney transplants (27%) were placed intraperitoneally in children mean age 5.5 ± 2.3 years (range 1.6-10 years) with median body weight 18.2 ± 5 kg (range 11.4-28.6 kg) during the study period. Two patients (4%) had vascular complications; 10 (22%) had urologic complications requiring intervention; all retained graft function. Thirteen patients (28%) had prolonged post-operative ileus. Eight (17%) patients had rejection episodes ≤6 months post-transplant. Only one case resulted in graft loss and was associated with recurrent focal segmental glomerular sclerosis (FSGS). Two patients (4%) had chronic rejection and subsequent graft loss by 5-year follow-up. At 7-year follow-up, graft survival was 93% and patient survival was 98%. Conclusions:The intraperitoneal approach offers access to the great vessels, which allows greater inflow and outflow and more abdominal capacity for an adult donor kidney, which is beneficial in very small patients. Risk of graft failure and surgical Pediatric patients constitute <2% of the kidney transplant recipients in the United States and offer unique surgical challenges for transplant. 1 Historically, matching donor size and age for pediatric patients led to significant graft loss, largely a result of vessel thromboses when small, pediatric kidneys were implanted in small, pediatric recipients. 2 Kidney transplants from larger and older donors are now routinely used in small pediatric patients, necessitating renal artery and vein anastomoses to larger recipient blood vessels, usually the aorta and inferior vena cava (IVC) depending on the recipient size, anatomical limitations and surgeon's preference. 3 In the current era, patient and graft survival for small pediatric patients weighing <30 kg is similar to adult outcomes, though smaller patients may still be at increased risk for vascular complications. [4][5][6][7][8] Several studies indicate that vascular complications are more common in pediatric than adult transplant recipients 7 and may be the most frequent complication in pediatric patients, with one study reporting vascular complication rates as high as 13.8%. 7,9 Additionally, renal vein thrombosis has been a major cause of firstyear graft failure in pediatric patients with increased risk in those <4 years old and those with lower body weight. 10,11 ...

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Long-term outcomes of living-donor kidney transplant children weighing less than 15 kg: Comparison of the surgical approach

Cited by 5 publications

References 22 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

Novel Histopathologic and Ultrastructural Findings in Renal Allografts From Patients With Size and Age Mismatches: A Case Series

Good outcomes after pediatric intraperitoneal kidney transplant

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