Overcoming anatomical barriers in pediatric kidney transplantation

Pediatric kidney transplantation in patients with inherited disorders and associated congenital anomalies constitutes a true challenge, especially in low weight recipients (< 15-20 kg). Potential barriers for a successful transplant involve size-mismatch between donor organ and recipient as well as identification of suitable vascular anastomotic sites in case of vascular anomalies. CASE - DIAGNOSIS/TREATMENT: We present a case of a 5-year-old girl with azygos continuation of the inferior vena cava (IVC), a condition generally precluding transplantation of an adult-sized kidney as adequate venous outflow from the transplant cannot be achieved. By interposing a prosthetic vascular graft, the donor renal vein was anastomosed to the suprahepatic IVC, thereby enabling transplantation of a live donor kidney to the pediatric recipient with the technical success being reflected in immediate graft function.

Anatomical barriers such as azygos continuation of the IVC do not preclude kidney transplantation from a size-mismatched adult live donor a priori but demand a patient-tailored innovative surgical approach and a committed multidisciplinary perioperative management to potentially overcome this kind of vascular anomaly.