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Published on: August 21, 2020
Current management issues of immediate postoperative care in pediatric kidney transplantation
Fabio Cesar Miranda Torricelli1, Andreia Watanabe2, Elias David-Neto3
1Division of Urology, Medical School, University of Sao Paulo, Sao Paulo, SP, Brazil.
Insights
Immediate postoperative care for pediatric kidney transplant recipients is crucial for favorable outcomes. Key management aspects include intensive care, fluid/electrolyte balance, blood pressure control, and vigilant graft monitoring.
Area of Science:
- Nephrology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Pediatric kidney transplantation is increasing globally.
- Long-term outcomes are favorable, yet immediate postoperative care is under-addressed.
- Unique physiological needs of children require specialized management.
Purpose of the Study:
- To outline essential immediate postoperative care strategies for pediatric kidney transplant recipients.
- To highlight critical aspects of management in the early post-transplant phase.
- To provide a guide for clinicians managing this unique patient population.
Main Methods:
- Postoperative management in a pediatric intensive care unit.
- Close monitoring of fluid balance, electrolytes, and blood pressure.
- Prophylactic antibiotic, antiviral, and thrombotic therapies based on risk assessment.
- Routine Doppler ultrasound for graft surveillance.
- Judicious use of abdominal drains for high-risk patients.
- Initiation of immunosuppressive regimens including induction and maintenance therapy.
Main Results:
- Specialized pediatric intensive care unit management is recommended.
- Fluid balance, electrolyte, and blood pressure control are paramount.
- Prophylactic therapies (antibiotic, antiviral, thrombotic) are tailored to individual risk.
- Doppler ultrasound is essential for early graft dysfunction detection.
- Immunosuppression involves induction and maintenance agents.
Conclusions:
- Comprehensive postoperative care is vital for successful pediatric kidney transplantation.
- Multifaceted management including intensive monitoring and tailored prophylaxis optimizes outcomes.
- Standardized protocols for immediate post-transplant care are needed.
Abstract:
The number of pediatric kidney transplants has been increasing in many centers worldwide, as the procedure provides long-lasting and favorable outcomes; however, few papers have addressed the immediate postoperative care of this unique population. Herein, we describe the management of these patients in the early postoperative phase. After the surgical procedure, children should ideally be managed in a pediatric intensive care unit, and special attention should be given to fluid balance, electrolyte disturbances and blood pressure control. Antibiotic and antiviral prophylaxes are usually performed and are based on the recipient and donor characteristics. Thrombotic prophylaxis is recommended for children at high risk for thrombosis, although consensus on the optimum therapy is lacking. Image exams are essential for good graft control, and Doppler ultrasound must be routinely performed on the first operative day and promptly repeated if there is any suspicion of kidney dysfunction. Abdominal drains can be helpful for surveillance in patients with increased risk of surgical complications, such as urinary fistula or bleeding, but are not routinely required. The immunosuppressive regimen starts before or at the time of kidney transplantation and is usually based on induction with monoclonal or polyclonal antibodies, depending on the immunological risk, and maintenance with a calcineurin inhibitor (tacrolimus or ciclosporin), an anti-proliferative agent (mycophenolate or azathioprine) and steroids.
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