Simultaneous Native Right Nephrectomy and Extraperitoneal Pediatric Kidney Transplantation Using the Same Incision...

Area of Science:

• Pediatric Surgery
• Nephrology
• Transplantation Surgery

Background:

• Kidney transplantation is optimal for pediatric end-stage kidney disease but faces challenges with donor-recipient size mismatch.
• The extraperitoneal approach is preferred over the intraperitoneal route due to lower morbidity.
• Native kidney nephrectomy is often required with the extraperitoneal approach to optimize graft placement.

Purpose of the Study:

• To assess clinical outcomes of simultaneous native right nephrectomy and extraperitoneal kidney transplantation in pediatric recipients.
• To evaluate the safety and feasibility of a single-incision approach for these combined procedures.
• To determine if this approach avoids the need for staged procedures or multiple incisions.

Main Methods:

• Retrospective review of pediatric patients (age ≤18 years) undergoing simultaneous right native nephrectomy and open extraperitoneal kidney transplant.
• Study period: 2017-2023 at a single center.
• Analysis of perioperative data, graft function, and complications.

Main Results:

• Seven pediatric patients (median age 4 years, all male) underwent the combined procedure.
• Median recipient weight was 16.5kg; donors included both deceased and living related individuals.
• No cases of delayed graft function, vascular, or urological complications were reported; excellent graft function was observed post-transplant.

Conclusions:

• Simultaneous extraperitoneal kidney transplantation with native nephrectomy via a single incision is safe and feasible in pediatric patients.
• This approach effectively manages donor-recipient size mismatch and avoids staged procedures.
• The technique offers a simplified surgical strategy with favorable early outcomes.