Surgical complications after pediatric kidney transplantation
Aydincan Akdur1, Esra Baskin2, Zeynep Ersoy3, Gokhan Moray1, Mehmet A. Haberal1.
1Transplantation, Baskent University, Ankara, Turkey; 2Pediatric Nephrology, Baskent University, Ankara, Turkey; 3Anesthesiology, Baskent University, Ankara, Turkey
Introduction: Kidney transplantation (KT) plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of pediatric patients. This study aims to evaluate the surgical complications after pediatric KT in our centre.
Materials and Methods: From November 1975 to November 2019, we performed 3080 KT procedures at 2 different centers by the same transplantation team. 355 of them were children (age ≤ 18 y). We reviewed the medical records of these 355 recipients for the following: primary cause of liver failure, age and weight at time of transplantation, type of graft, and medical outcomes of the recipient and donor. 113 (31,9%) were deceased donor transplantation (DDT) and 242 (68,1%) were living donor transplantation (LDT). At our institution, we perform renal arterial anastomoses and ureteral anastomoses by means of a corner saving technique. There was no major donor morbidity and no donor mortality.
Results: 215 of the patients were girls and 140 were boys with a mean age of 13.6±4.1 y (range, 1–18 y). During the early postoperative period; we had 2 renal artery thrombosis (RAT), 1 renal artery kinking (RAK), 2 renal vein thrombosis (RVT), and 2 renal vein kinking (RVK). We performed surgery in 6 patients for vascular complications. We performed thrombectomy for RAT and RVT. For RAK and RVK we rearranged the position of the grafts. Urinary leak was revealed in 6 patients during the early postoperative period. We didn’t use double J stent during transplant surgery in these 6 patients. After urinary leak was revealed we treated them with interventional radiological techniques. Interventional radiologists placed nephroureterocystostomy catheter in all patients. During the late follow up period, renal arterial stenosis was identified in 3 patients and they were managed with percutaneous angiography and stenting. The incidence of symptomatic lymphoceles after pediatric KT in our center has been 4.2%. Percutaneous drainage was used for the treatment of lymphocele. The 5-year patient survival rates were 91.9%. There was no mortality due to surgical complications.
Conclusions: Graft survival dramatically increased over the past years and is now superior to those observed in adult kidney transplantation, particularly in experienced team with microsurgery skills.
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