Inverted kidney allograft technique in pediatric kidney transplantation Results from a single-center, comparative...

Kidney transplantation (KT) is the standard of care for children with end-stage kidney disease. When the donor's kidney is right-sided, the graft can be placed ipsilaterally using an inverted kidney allograft (IKA) technique, facilitating the anastomosis of a shorter renal vein and renal hilum spatial orientation with anterior positioning of the urinary tract. We aimed to compare the safety and efficacy of IKA and standard anatomical position (AP) in pediatric KT.

We performed a retrospective study of all patients ≤18 years of age who underwent KT at the Hospital Italiano de Buenos Aires (January 2010 to December 2021). A comparative analysis of baseline demographics, urologic and vascular complications, graft survival, and one-year creatinine clearance was performed between patients with IKA and those with AP allografts.

Overall, 157 KT were performed: 61 were IKA and 96 were in the AP. Median age at transplantation was nine years (range 1-18). Allografts from cadaveric donors were more frequently implanted using the IKA technique (p≤0.001). No significant difference in urologic (16.4% vs. 13.5%, p=0.79) or vascular complication rates (1.2% vs. 5.2%, p=0.47) were observed. Median one-year creatine clearance was similar between the groups (73.1 ml/min/m² vs. 75.3 ml/min/m²). Graft survival and overall mortality rates were comparable between groups.

In the largest study of its kind, we observed that the IKA technique did not increase the risk of urologic or vascular complications and yielded comparable one-year graft survival and creatine clearance. This approach appears to be feasible when the AP is not ideal.