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Kidney transplant in children weighing less than 15 kg: donor selection and technical considerations
Michael Neipp1, Gisela Offner, Rainer Lück
1Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany.
Insights
Kidney transplantation (KTx) is feasible in children under 15 kg. Improved surgical techniques ensure successful outcomes, even with adult donor organs, demonstrating high patient and graft survival rates.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Organ Transplantation
Background:
- Kidney transplantation (KTx) in children weighing less than 15 kg presents unique surgical challenges.
- Recipient size discrepancy necessitates specialized approaches for successful outcomes.
Purpose of the Study:
- To analyze patient and donor factors influencing outcomes in pediatric kidney transplantation for recipients under 15 kg.
- To evaluate the feasibility and success of KTx in this challenging small child cohort.
Main Methods:
- Retrospective analysis of 64 children (<15 kg) undergoing 68 kidney transplants.
- Grafts from cadaveric (CAD) and living-related donors (LRD) were utilized.
- Transperitoneal and extraperitoneal approaches were employed, with routine vascular anastomoses to aorta and vena cava.
Main Results:
- Initial graft function was achieved in 88% of cases, with higher rates from LRD (100%) versus CAD (82%).
- 1-, 5-, and 10-year patient survival rates were 93%, 91%, and 91%, respectively.
- 1-, 5-, and 10-year graft survival rates were 92%, 85%, and 85%, respectively; CAD graft survival improved with donors >12 years.
Conclusions:
- Kidney transplantation is a viable option for children weighing <15 kg.
- Improved surgical techniques facilitate successful transplantation, even with adult donor organs placed in the iliac fossa.
- High patient and graft survival rates support the efficacy of KTx in this pediatric population.
Background:
Small children represent a challenging patient group in kidney transplantation (KTx). The aim of this study was to analyze patient and donor data influencing outcome in children that weighed <15 kg.
Methods:
Sixty-eight kidneys were transplanted in 64 children that weighed <15 kg. In 44 cases, kidneys came from cadaveric donors (CAD) and in 24 cases from living-related donors (LRD). Grafts were placed transperitoneally via midline incision (n=16) or extraperitoneally to the iliac fossa (n=52). Vascular anastomoses were routinely performed to the aorta and vena cava even when the extraperitoneal approach was used.
Results:
Vascular thrombosis was observed in two (3%), urinary leaks in five (7%), and stenosis in four (6%) patients. In six children receiving organs from adults to the iliac fossa, wound closure was performed using an absorbable mesh to avoid organ compression. Initial graft function occurred in 60 cases (88%). Frequency of initial graft function was significantly higher after KTx from LRD (100%) compared with CAD (82%). The 1-, 5-, and 10-year patient survival was 93%, 91%, and 91%, respectively, and the 1-, 5-, and 10-year graft survival was 92%, 85%, and 85%, respectively. There was no significant difference in patient and graft survival when KTx from LRD and CAD were compared. Within the CAD group, graft survival was improved using kidneys from donors >12 years compared with younger donors.
Conclusion:
Despite size discrepancy between recipients and grafts, KTx is feasible in children that weigh <15 kg by using an improved surgical technique even when adult organs are placed to the iliac fossa.