The use of porcine dermal collagen implants in assisting abdominal wall closure of pediatric renal transplant recipients with donor size discrepancy

Abstract

Children may have kidneys transplanted from donors larger than themselves. Abdominal wall closure may be difficult, with risks of abdominal compartment syndrome and graft compromise. Meshes used to facilitate closure may cause dense intra-abdominal adhesions, making further surgery or peritoneal dialysis difficult. We present five cases in which abdominal wall closure was facilitated by porcine dermal collagen implant. Five children (2-15 yr) received transplanted kidneys from adult donors of significantly greater weight. In four recipients, the kidney was transplanted onto the aorta and vena cava intra-abdominally using a midline incision. In the fifth, the kidney was anastomosed onto the iliac vessels. The skin overlying the implant was closed normally. Maximum follow-up was three yr. In all cases, primary closure was achieved. One child received a second intra-abdominal transplant as an emergency, which later failed. The other kidneys are functioning well. One recipient developed a small incisional hernia three yr post-transplant. Another developed a skin dehiscence over the implant 23 days post-operatively. The implant was removed and skin closed. The other two recipients recovered well. Porcine dermal collagen implant is a helpful adjunct to abdominal wall closure following organ transplantation in children with donor size discrepancy.

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

“…Similarly, Pentlow et al [24] published a study on the use of porcine prostheses in the closure of the abdominal wall in 5 pediatric recipients (5e12 years) of adult donors, followed for 3 years, during which it proved to be a useful aid in all cases of kidney transplantation in which there was a size discrepancy between donor and recipient.…”

“…In fact, according to Horrow et al [20], Doppler US monitoring of transplanted kidney located approximately 8% of patients with abnormal flow; of these, only 34% were subjected to an urgent reintervention, and half of these were really suffering from RACS for which decompression warranted restoration of function. Given this experience with patients affected by RACS, there are experiences of other authors who acted before the onset of RACS, performing surgical decompression techniques during the transplantation, as in studies of Richards [23] and Pentlow [24]. In a series of 600 transplanted patients, Wood [13] performed decompression techniques on 134 (22%); among these, 123 (20.5%) underwent closure of the abdominal wall with polypropylene prosthesis during transplantation, as the discrepancy between the space of positioning and the size of the kidney was at high risk of onset of RACS in the immediate postoperative period; in 11 patients (1.8%) decompression was performed early posttransplantation for the onset of a real RACS.…”

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“…10 It is soft and flexible, and it has bilateral smooth surfaces with high tensile strength. 10 It is sold in sheets, allowing it to be cut to shape, and provides the largest grafts available (maximum size, 28 × 40 cm). 8,10 In animal studies, a porcine dermal collagen implant produced a substantially weaker inflammatory response and less extensive, less dense adhesions.…”

“…6,8 Porcine dermis is the closest to human dermis and it is not cytotoxic, hemolytic, pyrogenic, or allergenic, and it does not elicit a foreign body response. 10 It is colonized by host tissue cells and blood vessels that minimize the risk of infection. 10 It is soft and flexible, and it has bilateral smooth surfaces with high tensile strength.…”

“…10 It is colonized by host tissue cells and blood vessels that minimize the risk of infection. 10 It is soft and flexible, and it has bilateral smooth surfaces with high tensile strength. 10 It is sold in sheets, allowing it to be cut to shape, and provides the largest grafts available (maximum size, 28 × 40 cm).…”