Percutaneous interventions in adults receiving pediatric "en bloc" double renal grafts

To present technical adaptations of percutaneous interventional techniques required for the small size vessels and ureters of "en bloc" transplanted pediatric kidneys.

Over a 4-year period, 12 adult patients received en bloc pediatric double renal transplants. Small system percutaneous interventional techniques were used in seven patients to approach the infantile renal arteries and urinary collecting systems for 11 percutaneous transluminal renal angioplasties, 4 antegrade pyelograms, and 3 nephrostomies.

Prior to intervention, these patients averaged a creatinine of 2.5 mg%, which decreased to 1.4 mg% at 46 months (range, 22-68) following the first intervention. With a mean follow-up of 42 months (range, 5-47), 9 of 12 (75%) transplants are functioning with an average serum creatinine of 1.3 mg%.

With the assistance of percutaneous management of postoperative arterial and ureteral lesions, the prognosis of en bloc renal grafts can approach that of the standard adult renal allograft.