Insights in Transplanting Complex Pediatric Renal Recipients With Vascular Anomalies

Area of Science:

• Pediatric Nephrology
• Vascular Surgery
• Transplantation Immunology

Background:

• Children with end-stage kidney disease (ESKD) often present with complex vascular anomalies complicating renal transplantation.
• These anomalies include iatrogenic or congenital conditions, alongside significant comorbidities, posing unique surgical challenges.
• One case involved blood group incompatibility, further increasing complexity.

Observation:

• Five pediatric patients (aged 3-17 years) with ESKD and vascular anomalies underwent renal transplantation.
• Four patients had inferior vena cava or iliac vein occlusion; two had prior complex vascular reconstructions.
• Pre-transplant surgical assessment was initiated in two recipients prior to donor nephrectomy to ensure implant feasibility.

Findings:

• The study reported 80% patient survival (4/5) post-transplantation, with one death from sepsis despite a functioning graft.
• Two cases experienced delayed graft function, but 100% death-censored renal allograft survival was achieved at a median follow-up of 19 months.
• Estimated glomerular filtration rates ranged from 43-72 mL/min/1.73 m² (median 55).

Implications:

• Major vascular anomalies do not preclude successful kidney transplantation in complex pediatric recipients.
• Pre-transplant surgical exploration is valuable for assessing feasibility and safety in uncertain cases.
• A novel classification system for congenital vascular abnormalities was developed to aid in complex pediatric transplantation.