Renal transplantation in children: Critical analysis of age related surgical complications

Abstract

To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.

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“…20 The reported incidence of VUR ranges from 3.0% to 12.4%, although notably several of these studies involved the pediatric population. [25][26][27][28] In a single institution study of 2500 transplants over a 16-year period by a single transplant urologist, symptomatic VUR was reported in 3% (78 patients). 21 The average time to presentation was 3.5 years (0.5-15 y), and the most common presentation was recurrent UTI.…”

Pediatric transplantation: preventing thrombosis

“…Irtan (2010) [51] France R/C KT 0-21 LMWH in selected cases GT 3% Ismail (1997) [77] Poland R/C KT 0-18 Not described GT 4% Jain (2006) [78] USA R/C LT All Anticoagulation (not defined) HAT 6.7%…”

“…Graft thrombosis is the second most common cause of graft loss (after rejection) with an overall incidence of around 2-3% (accounting for 10-15% of graft failure); however, there is wide variability (0-12%) between centers [47][48][49][50][51][52][53][54][55]. Risk factors for graft thrombosis include young recipient age (< 2 years), young donor age (< 5 years), donor-recipient vessel disparity, prolonged cold ischemic time, inherited and acquired thrombophilia, and preexisting thrombosis elsewhere [55,56].…”

Insuffisance rénale chronique de l’enfant

“…La proportion de greffes préemptives varie selon les pays et les centres : en moyenne 15 % des greffes en France, 50 % dans les pays nordiques et 24 % aux États-Unis. [25], le nombre de vaisseaux du greffon entre en ligne de compte dans le choix du rein afin d'éviter le cumul de risque thrombogène. La recherche de facteurs endogènes de thrombophilie est réalisée chez les receveurs avant la transplantation (V.-Leiden, mutation de la protéine C, S, prothrombine, MTHFR, déficit en ATIII et antiphospholipides) et une anticoagulation est systématique dans tous les cas (durée variable).…”