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 complications were not increased when compared to other published data on pediatric kidney transplants.

CONFLICT OF INTEREST

The listed authors of this manuscript have no conflicts of interest to disclose.

Open Research

DATA AVAILABILITY STATEMENT

The derived data supporting the findings of this study are available from the corresponding author on request.

REFERENCES

1 UNOS Transplants by age of recipient. https://unos.org/data/. Accessed September 1, 2018.
Google Scholar
2Verghese PS. Pediatric kidney transplantation: a historical review. Pediatr Res. 2017; 81(1): 259–264.
10.1038/pr.2016.207
PubMed Web of Science® Google Scholar
3Cho MH. Pediatric kidney transplantation is different from adult kidney transplantation. Korean J Pediatr. 2018; 61(7): 205–209.
10.3345/kjp.2018.61.7.205
PubMed Google Scholar
4Hart JM, Smith MA, Skeans SK, et al. OPTN/SRTR 2017 annual data report: kidney. Am J Transplant. 2019; 19: 19–123.
10.1111/ajt.15274
PubMed Web of Science® Google Scholar
5Vitola SP, Gnatta D, Garcia VD, et al. Kidney transplantation in children weighing less than 15 kg: extraperitoneal surgical access-experience with 62 cases. Pediatr Transplant. 2013; 17(5): 445–453.
10.1111/petr.12104
CAS PubMed Web of Science® Google Scholar
6West M, Pirenne J, Chavers B, Gillingham K, Der S. Clostridium difficile colitis after kidney and kidney-pancreas transplantation. Clin Transplant. 1999; 13(4): 318–323.
10.1034/j.1399-0012.1999.130407.x
CAS PubMed Web of Science® Google Scholar
7Akbar SA, Zafar Jafri SH, Amendola MA, Madrazo BL, Salem R, Bis KG. Complications of renal transplantation. Radiographics. 2005; 25(5): 1335–1356.
10.1148/rg.255045133
PubMed Web of Science® Google Scholar
8Pant C, Deshpande A, Desai M, Jani BS, Sferra TJ, Gilroy R. Outcomes of Clostridium difficile infection in pediatric solid organ transplant recipients. Transpl Infect Dis. 2016; 18: 31–36.
10.1111/tid.12477
CAS PubMed Web of Science® Google Scholar
9Irtan S, Maisin A, Baudouin V, et al. Renal transplantation in children: critical analysis of age related surgical complications. Pediatr Transplant. 2010; 14(4): 512–519.
10.1111/j.1399-3046.2009.01260.x
CAS PubMed Web of Science® Google Scholar
10Wang C-S, Greenbaum LA, Patzer RE, et al. Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation. Pediatr Nephrol. 2019; 34: 1545–1555.
10.1007/s00467-019-04264-0
PubMed Web of Science® Google Scholar
11van Lieburg AF, de Jong MCJW, Hoitsma AJ, Buskens FGM, Schröder CH, Monnens LAH. Renal transplant thrombosis in children. J Pediatr Surg. 1995; 30(4): 615–619.
10.1016/0022-3468(95)90144-2
PubMed Web of Science® Google Scholar
12Shapiro R, Sarwal MM. Pediatric kidney transplantation. Pediatr Clin North Am. 2010; 57(2): 393–400.
10.1016/j.pcl.2010.01.016
PubMed Web of Science® Google Scholar
13Dharnidakarka VR, Fiorina P, Harmon WE. Kidney transplantation in children. N Engl J Med. 2014; 371(6): 549–558.
10.1056/NEJMra1314376
PubMed Web of Science® Google Scholar
14Weitz M, Laube GF, Schmidt M, et al. Outcome of renal transplantation in small infants: a match-controlled analysis. Pediatr Nephrol. 2018; 33: 1057–1068.
10.1007/s00467-018-3895-5
PubMed Web of Science® Google Scholar
15Gander R, Asensio M, Royo G, et al. Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome. J Pediatr Urol. 2017; 13(3): 279.
10.1016/j.jpurol.2017.02.025
PubMed Web of Science® Google Scholar
16Aoki Y, Satoh H, Sato A, et al. Long-term outcomes of living-donor kidney transplant children weighing less than 15 kg: comparison of the surgical approach. J Pediatr Urol. 2021; 17(4): 542.e1–542.e8.
10.1016/j.jpurol.2021.05.021
PubMed Web of Science® Google Scholar
17Taher A, Zhu B, Ma S, et al. Intra-abdominal complications after pediatric kidney transplantation: incidence and risk factors. Transplantation. 2019; 103(6): 1234–1239.
10.1097/TP.0000000000002420
PubMed Web of Science® Google Scholar
18Muramatsu M, Mizutani T, Hamasaki Y, et al. Transplantation of adult-size kidneys in small pediatric recipients: a single-center experience. Pediatr Transplant. 2019; 23(4):e13401.
10.1111/petr.13401
PubMed Web of Science® Google Scholar
19Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. J Am Soc Nephrol. 2009; 4(11): 1832–2643.
10.2215/CJN.01640309
Web of Science® Google Scholar
20 North American Pediatric Renal Trials and Collaborative Studies 2014 Annual Report. 2014. https://naprtcs.org/system/files/2014_Annual_Transplant_Report.pdf. Accessed September 1, 2018.
Google Scholar
21 USRDS Chapter 7: ESRD among Children, Adolescents, and Young Adults. 2018. https://www.usrds.org/media/1737/v2_c07_esrd_pediatric_18_usrds.pdf. Accessed September 1, 2018.
Google Scholar
22Gander R, Asensio M, Royo GF, et al. Vascular thrombosis in pediatric kidney transplantation: Graft survival is possible with adequate management. J Pediatr Urol. 2018; 14(3): 222–230.
10.1016/j.jpurol.2018.01.027
PubMed Web of Science® Google Scholar
23Chavers BM, Rheault MN, Matas AJ, et al. Improved outcomes of kidney transplantation in infants (age < 2 years): a single-center experience. Transplantation. 2018; 102(2): 284–290.
10.1097/TP.0000000000001929
PubMed Web of Science® Google Scholar
24El Zorkany K, Bridson J, Sharma A, Halawa A. Transplant renal vein thrombosis. Exp Clin Transpl. 2017; 15(2): 123–129.
PubMed Web of Science® Google Scholar
25Sugi MD, Albadawi H, Knuttinen G, et al. Transplant artery thrombosis and outcomes. Cardiovasc Diagn Ther. 2017; 7(Suppl 3): S219–S227.
10.21037/cdt.2017.10.13
PubMed Web of Science® Google Scholar
26Salvatierra OJ, Singh T, Shifrin R, et al. Successful transplantation of adult-sized kidneys into infants requires maintenance of high aortic blood flow. Transplantation. 1998; 66(7): 819–823.
10.1097/00007890-199810150-00001
PubMed Web of Science® Google Scholar
27Almeida F, Branco F, Cavadas V, et al. Urological complications after 134 pediatric kidney transplants: a single-center study. Transplant Proc. 2013; 45: 1096–1098.
10.1016/j.transproceed.2013.02.003
CAS PubMed Web of Science® Google Scholar
28Loiseau Y, Bacchetta J, Klich A, et al. Renal transplantation in children under 3 years of age: experience from a single-center study. Pediatr Transplant. 2018; 22(2): 1–10.
10.1111/petr.13116
Web of Science® Google Scholar
29Lee E, Steven GR, Nancy JS, Vakili K, Bae H. Perioperative renal transplantation management in small children using adult - sized living or deceased donor kidneys a single - center experience. Pediatr Transplant. 2019; 23(7): 1–7.
10.1111/petr.13553
Web of Science® Google Scholar
30Nahas WC, Mazzucchi E, Scafuri AG, et al. Extraperitoneal access for kidney transplantation in children weighing 20 kg or less. J Urol. 2000; 164: 475–478.
10.1016/S0022-5347(05)67403-4
CAS PubMed Web of Science® Google Scholar
31Herthelius M, Celsi G, Edström Halling S, et al. Renal transplantation in infants and small children. Pediatr Nephrol. 2012; 27: 145–150.
10.1007/s00467-011-1962-2
PubMed Web of Science® Google Scholar

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Volume26, Issue6

September 2022

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Good outcomes after pediatric intraperitoneal kidney transplant

Abstract

Background

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Conclusions

CONFLICT OF INTEREST

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Good outcomes after pediatric intraperitoneal kidney transplant

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Open Research

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