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Updated: Aug 19, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Excellent outcome in infants and small children with thrombophilias undergoing kidney transplantation
Andre A Dick1, Susan M Lerner, Adrienne R Boissy
1Department of Surgery, Penn State University, Hershey, PA 17033, USA.
Insights
Pediatric renal transplant recipients with thrombophilia, such as protein C, protein S, and factor V Leiden deficiencies, face a high risk of graft thrombosis. Early diagnosis and peri-operative anticoagulation can prevent adverse outcomes in these young patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Hematology
Background:
- Vascular thrombosis is a leading cause of early graft loss in pediatric renal transplantation.
- Thrombophilias, including protein C, protein S, and factor V Leiden deficiencies, are known risk factors for thrombosis.
- Limited data exists on the outcomes of renal transplantation in infants and small children with thrombophilias.
Purpose of the Study:
- To review the institution's experience with the diagnosis, peri-operative management, and follow-up of pediatric renal transplant recipients with thrombophilias.
- To assess the incidence of graft thrombosis in this high-risk population.
- To identify strategies for improving outcomes in infants and small children undergoing renal transplantation with thrombophilia.
Main Methods:
- Retrospective analysis of pediatric renal transplant recipients from May 2000 onwards.
- Data collected from the institution's Pediatric Transplant Registry.
- Identification of patients with thrombophilias (factor V Leiden mutation, protein S deficiency) and review of their management and outcomes.
Main Results:
- Three pediatric patients with thrombophilias (one factor V Leiden, two protein S deficiency) underwent renal transplantation.
- All transplants were from living donors and patients received peri-operative anticoagulation.
- No adverse outcomes or graft thrombosis were observed in children with thrombophilias, despite lower mean weight compared to controls.
Conclusions:
- Thrombophilia is a significant, potentially under-recognized cause of graft thrombosis in pediatric renal transplant recipients.
- A high index of suspicion, preoperative screening for thrombophilias, and appropriate anticoagulation management are crucial.
- These strategies may reduce the incidence of graft thrombosis in infants and small children undergoing renal transplantation.
Abstract:
One of the most common causes of early graft failure in children undergoing renal transplantation is vascular thrombosis. Numerous risk factors for graft thrombosis have been previously described. Children with various types of thrombophilias such as protein C, protein S and factor V Leiden deficiencies are at an increased risk for vascular thrombosis. Infants and small children with these disorders undergoing renal transplantation have not been well documented in the literature. We reviewed our experience in the diagnosis, peri-operative management and follow up of these patients at our institution. A retrospective analysis of all children undergoing renal transplantation at our institution, using data obtained from the Pediatric Transplant Registry at our institution since May 2000 was performed. The indications for renal transplant included focal segmental glomerulosclerosis, renal dysplasia and reflux nephropathy. One patient had factor V Leiden mutation and two patients had protein S deficiency. Patients were anticoagulated in the peri-operative and post-transplant period. All index transplants were performed with living donor kidneys. There were no adverse outcomes in children with thrombophilias despite having significantly lower weight at the time of transplant vs. children without thrombophilia. The incidence of graft thrombosis in the pediatric renal transplant recipients is high. We identify a potential cause of thrombosis in children not well documented in the literature. A high index of suspicion combined with preoperative screening and diagnosis of thrombophilias and an appropriate treatment plan may decrease the incidence of graft thrombosis in infants and small children undergoing renal transplantation.
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