E. A. Gerzina1, A. Huynh1, A. Thorsen1, D. O’Conor1, G. Tan1, T. Malik1, K. Bhakta2, C. O’Mahony3, E. Brewer4, T. Galván3 1Baylor College Of Medicine,Houston, TX, USA 2Texas Children’s Hospital,Renal,Houston, TX, USA 3Baylor College Of Medicine,Division Of Abdominal Transplant,Houston, TX, USA 4Baylor College Of Medicine,Department Of Pediatrics-Renal,Houston, TX, USA
Introduction: Renal transplantation in small children weighing <30 kg is technically demanding often due to patient size, donor-recipient size mismatch, and the congenital structural abnormalities that frequently cause ESRD in children. Though patient and allograft survival for this population is on par with adult outcomes, some studies have reported a higher incidence of certain complications. Our study reviewed cases of kidney transplantation in small children from a high-volume surgical center in Houston, TX, in order to assess post-operative complications and outcomes and determine what risks, if any, this patient population may continue to face.
Methods: We conducted a retrospective chart review of all patients receiving intraperitoneal renal transplants at our institution from April 2011 to March 2018. There were 48 intraperitoneal transplants in patients weighing <30 kg. We excluded patients who had a retransplant or multiple organ transplants. We assessed patient outcomes including major surgical complications, episodes of acute rejection, and patient and allograft survival.
Results:
Out of 168 renal transplant patients, 49 weighed <30 kg, and 48 of 49 received an intraperitoneal transplant. Of these, 28 (58.3%) received a deceased donor kidney, and 20 (41.7%) received a living donor kidney. Mean body weight was 19.1 kg ± 5.2 kg. Eight patients (16.7%) had postoperative complications. Renal vein thrombosis occurred in 2 patients (4.2%), and two had postoperative hematomas. Primary graft dysfunction, renal artery thrombosis, urinary leak and urinary stricture occurred in 1 patient each (2.1%). Eight patients (16%) had acute rejection who were treated <6 mos from transplant and 3 patients (6%) treated ≥ 6 mos post-transplant. At the time of last follow-up (max 85 mos), patient survival was 97.9% and graft survival was 93.75%. Two patients lost allografts due to chronic rejection. One patient had an episode of acute cellular rejection on POD 19 which did not resolve; he is currently on chronic peritoneal dialysis and is awaiting retransplant.
Conclusion:
Although renal transplant in <30 kg pediatric patients confers greater technical challenges, it did not result in a significantly increased risk of graft failure or overall complication rates compared to either pediatric or adult transplant recipients at large, though we did see a larger proportion of vascular complications. Interestingly, while vascular complications are responsible for about 10% of graft failures in children, no patients in this study experienced graft loss due to this cause. Their rates of urinary complications were also on par with the adult rate, in spite of frequently abnormal urological anatomy. Overall, our findings indicate that despite inherent technical challenges to renal transplantation in children weighing <30 kg, their outcomes and risks of complications do not vary significantly from that of the general population.