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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Renal transplantation in children
H Sözen1, A Dalgic, H Karakayali
1Department of General Surgery, Baskent University Hospital, Ankara, Turkey.
Insights
Pediatric kidney transplant recipients face unique challenges. Strict surgical techniques, improved immunosuppression, and prompt complication management can enhance outcomes for children undergoing renal transplantation.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Immunology
Background:
- Pediatric kidney transplant recipients present unique immunological, metabolic, and technical considerations compared to adults.
- Children undergoing renal transplantation have a higher potential for post-transplant complications.
- This study retrospectively analyzed 83 pediatric kidney transplant cases.
Purpose of the Study:
- To evaluate the outcomes and complications of kidney transplantation in pediatric recipients.
- To identify factors influencing graft and patient survival in children.
Main Methods:
- Retrospective analysis of 83 pediatric patients (ages 7-17) who received kidney transplants between 1975 and 2004.
- Data collected included patient demographics, surgical procedures, morbidities, and survival rates.
- Comparison of outcomes between living related and cadaveric transplantations.
Main Results:
- 16.3% of recipients experienced morbidities, including lymphocele (8.1%) and graft renal artery stenosis (2.3%).
- Patient survival rates at 1, 3, and 5 years were high (98%, 93%, 92%).
- Graft survival rates at 1, 3, and 5 years were 91%, 78%, and 67% for living related and 92%, 76%, and 65% for cadaveric transplants, respectively.
Conclusions:
- Optimal outcomes in pediatric renal transplantation necessitate meticulous surgical techniques.
- Effective immunosuppressive strategies and early management of complications are crucial.
- Adherence to these principles can improve long-term graft and patient survival in pediatric recipients.
Introduction:
Various immunological, metabolic, and technical factors render pediatric recipients with end-stage renal disease unique from their adult counterparts. In addition, the potential for complications after renal transplantation is far greater in children than in adults. In this study, we retrospectively analyzed 83 pediatric recipients who underwent kidney transplantation at our institution from 1975 to 2004.
Materials And Methods:
From November 1975 to December 2004, 1523 renal transplantations were performed at our institution with 56 procedures in 83 pediatric patients (44 boys and 39 girls; age range, 7 to 17 years; mean age, 14.9 +/- 2.2 years).
Results:
Long-term follow-up revealed the following morbidities in 14 (16.3%) recipients: lymphocele in 7 (8.1%) patients, perirenal hematoma in 2 (2.3%), graft renal artery stenosis in 2 (2.3%), ureteral stenosis in 2 (2.3%), and ureteral anastomotic leak in 1 (1.2%). Six (7.2%) recipients with a functioning graft died during follow-up (five deaths were infection related, and the cause of one death was unknown). Five grafts failed (four for immunological reasons and one as a result of recurrent disease). The 1-, 3-, 5-year patient and graft survival rates were 98%, 93%, 92% and 91%, 78%, 67% for living related transplantations versus 98%, 91%, 90% and 92%, 76%, 65% for cadaveric transplantations, respectively.
Discussion:
Better outcomes for renal transplantation in children may be obtained by strict adherence to precise surgical techniques, better immunosuppressive management, and early diagnosis/effective treatment of complications.
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