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Updated: Oct 3, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Safe Renal Transplantation to the Extraperitoneal Cavity in Children Weighing Less Than 15 kg
Keisuke Hata1, Hideki Ishida2, Kiyonobu Ishizuka3
1Department of Urology, Tokyo Women's Medical University, Tokyo.
Insights
Pediatric renal transplantation using the extraperitoneal approach has a low complication rate. Allograft placement in the extraperitoneal cavity is safe for children under 15 kg, with fewer complications.
Area of Science:
- Pediatric Surgery
- Nephrology
- Transplantation Immunology
Background:
- Pediatric renal transplantation is complex, with potential surgical complications in end-stage renal disease patients.
- The extraperitoneal approach is an alternative surgical technique for pediatric kidney transplants.
Purpose of the Study:
- To evaluate surgical complications of the extraperitoneal approach in pediatric renal transplantation.
- To identify risk factors for complications in pediatric kidney transplant recipients.
Main Methods:
- Retrospective study of 280 pediatric patients (<16 years) undergoing extraperitoneal renal transplantation.
- Transplant placement in iliac fossa (216 patients) or distal renal lower pole cavity (64 patients).
- Complications assessed using Clavien-Dindo classification; Cox regression analysis for risk factors.
Main Results:
- Overall complication rate: 10.7% (Grade 2) and 4.3% (Grade 3+).
- No gastrointestinal complications were reported.
- Complications associated with weight <15 kg and operative time >245 minutes.
- In patients <15 kg with distal allograft placement, complication rate was 6.1%.
Conclusions:
- The extraperitoneal approach is associated with manageable surgical complications in pediatric renal transplantation.
- Allograft placement in the extraperitoneal cavity is a safe option for children weighing less than 15 kg.
- Careful patient selection and operative technique are crucial for minimizing complications.
Abstract:
Pediatric renal transplantation is associated with various surgical complications due to the complexity of the technique and the often-fragile condition of patients with end-stage renal disease. We evaluated the surgical complications associated with renal transplantation via the extraperitoneal approach in pediatric recipients. This retrospective study enrolled 280 patients younger than 16 years old who underwent renal transplantation via the extraperitoneal approach: 216 patients underwent transplant placement in the iliac fossa like in adults, and 64 underwent transplant placement in the distal part of the original renal lower pole (the extraperitoneal cavity). On the basis of the Clavien-Dindo classification, 30 patients (10.7%) showed grade 2 complications and 12 patients (4.3%) showed grade 3 or higher complications. None of the patients showed gastrointestinal complications. In a Cox regression analysis, grade 2 or higher complications were significantly associated with weight less than 15 kg (P = .027) and operative times longer than 245 minutes (P = .029). Among the 49 patients weighing less than 15 kg with an allograft placed in a distal portion of the original renal lower pole, only 3 patients (6.1%) developed surgical complications. Thus, allograft placement in the extraperitoneal cavity can be performed safely in children weighing less than 15 kg.
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