Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome (original) (raw)
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Transplant international : official journal of the European Society for Organ Transplantation, 2017
Kidney transplantation (KT) is often delayed in small children because of fear of postoperative complications. We report early- and long-term outcomes in children transplanted at ≤15 kg in the two largest Belgian pediatric transplant centers. Outcomes before (period 1) and since the introduction of basiliximab and mycophenolate-mofetil in 2000 (period 2) were compared. Seventy-two KTs were realized between 1978 and 2016: 38 in period 1 and 34 in period 2. Organs came from deceased donors in 48 (67%) cases. Surgical complications occurred in 25 KTs (35%) with no significant difference between the two periods. At least one acute rejection (AR) occurred in 24 (33%) KTs with significantly less patients experiencing AR during period 2: 53% and 12% in period 1 and, period 2 respectively (P < 0.001). Graft survival free of AR improved significantly in period 2 compared with period 1: 97% vs. 50% at 1 year; 87% vs. 50% at 10 years post-KT (P = 0.003). Graft survival tended to increase ov...
SciDoc Publishers, 2019
Background: Renal transplantation (RT) is the treatment of choice for children with Chronic Kidney Disease (CKD). This technique benefits survival and quality of life. Long-term outcomes in pediatric transplantation have significantly improved over the past 20 years; however, children less than 5 years of age weighing 20 kg or less still remain a considerable challenge, with higher mortality rate and graft loss. Methods: In this article, we present the pediatric RT experience at Hospital Universitario de Cruces, the main center for transplants in Spain. Children who underwent RT within the period of January 2012-January 2017 were retrospectively reviewed to identify those with weight less than 20 Kg. The following parameters were collected: pre-transplant characteristics, surgical technique, anesthesia characteristics, intra-operative and post-operative surgical or medical complications, pre and post-transplant creatinine levels, renal graft survival, and late post-operative complications. Results: Within a period of 5 years, a total of 13 pediatric patients (weight ≤ 20kg) underwent RT at Hospital Universitario de Cruces. The patient sample represented 37.14 % of the 35 renal transplants performed on pediatric patients at this institution. All 13 patients received a standard surgical and anesthetic perioperative management. Post-transplant creatinine levels significantly decrease after surgery during the early postoperative period from 6.45 mg/dl preoperatively (range, 1.90-12.26) to 0.59 mg/dl postoperatively (range, 0.27-1.27). The mean follow-up period was 1.5 year (range, 1-3) with 12 patients out of 13 (92.31%) presenting with 1-year graft survival. Conclusions: A multidisciplinary collaboration, including surgeons, nephrologists, and anesthesiologists specialized in handling transplants for underweight children should be a priority. Close intraoperative monitoring of vital signs and optimal fluid therapy is essential for anesthetic management due to the possible perioperative hemodynamic changes.
Pediatric Transplantation, 2013
Small children are a challenging group in whom to perform KT. This retrospective study analyzed the results of 62 KTs in children weighing <15 kg, performed between 1998 and 2010, using extraperitoneal access and anastomosis of the renal vessels of donors to the aorta and IVC or iliac vessels of the recipients. Thirty‐two (51.6%) grafts were LRDTs and 30 (48.4%) were DDRTs—28 of them pediatric. The mean age at KT was 3.7 ± 2.2 yr (1–12), and the mean weight was 12.3 ± 2.1 kg (5.6–14.9). Ten children weighed <10 kg, and five (8.1%) children presented previous thrombosis of the venous system. At one and five yr, patient survival was 93.2% and 84.2%, and graft survival was 85.2% and 72.7%. There were no differences between the rates for LRDT and DDRT. There were six vascular complications (four vascular thromboses, one laceration, and one renal artery stenosis) and two perirenal collections. Extraperitoneal access is a valid KT technique in children weighing <15 kg.
Improved Outcomes of Combined Liver and Kidney Transplants in Small Children (<15 kg)
Transplantation, 2009
Background. Combined liver and kidney transplantation (CLKT) is a surgical challenge in small children because of technical aspects, lack of pediatric donors, and restrictions related to the size of the abdominal cavity. We report outcomes after CLKT in this challenging group of smaller children. Method. A review of prospective data on all children undergoing CLKT at the Birmingham Children's Hospital between 1994 and 2008 was performed. An analysis of perioperative data, complications, and survival in children less than 15 kg was carried out, with figures expressed as median (range) and compared with that of children more than 15 kg. Results. A total of 23 children underwent CLKT (14 male [61%] and age 8.6 [1.6-16.7] years), of which 8 (35%) were less than or equal to 15 kg, median age 2.2 (1.6-5.4) years, weight 11.6 (9.1-14.9) kg, and height 76 (66-95) cm, followed up for a median 26 (12-126) months. Donor details included age 13 (3-40) years, weight 60 (15-78) kg, and height 156 (83-168) cm. The median donor-to-recipient weight ratio was 4.8 compared with 1.7 for larger children. The median waiting time was 291 (48-523) compared with 150 (6-455) days for children more than 15 kg. Four of eight (50%) children received preoperative renal support, when compared with 10 of 16 (62%) children more than 15 kg. The intensive care unit and inpatient stay was 2 (2-22) days and 25 (19-93) days, respectively. Mortality was seen in one of eight because of sepsis and multiorgan failure. When compared with children more than 15 kg, survival figures at 1 and 2 years were 87% versus 93% and 78%, respectively. Conclusions. CLKT in small children results in comparable outcomes despite challenges related to donor-recipient size mismatch and longer waiting times. Consequently, body size/stature should not be a limiting factor for multiorgan transplantation.
Transplantation of pediatric renal allografts from donors less than 10 kg
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2018
Few transplant programs use kidneys from donors with body weight (BW) <10 kg. We hypothesized that pediatric en bloc transplants from donors with BW <10 kg, would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N=28). Data were stratified by smaller (donor BW less than 10 kg) (N=11) or larger donors (BW greater than 10 kg) (N=17). Renal volume was assessed during follow-up by ultrasound. Demographic characteristics were similar between the two groups of recipients. After mean follow-up of 44 months (smaller donors) and 124 (larger donors), graft and patient outcomes were similar between groups. Serum creatinine at 1, 3, and 5 years was no different between groups. At 1d post-transplant mean total renal volume in the smaller group was 28 ± 9 mm vs. 45 ± 12 mm (P <0.01). By 3 weeks, it was 53±19mm (smaller donors) vs. 73±19mm (larger donors) (P = NS). Complication rates ...
BMC Nephrology, 2020
Background: Access to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children. Methods: A total of 56 cases of single pediatric kidney transplantation and 26 cases of en bloc kidney transplantation from pediatric donors with body weight (BW) less than 10 kg were performed in two transplant centers in China and the transplant outcomes were retrospectively analyzed. Results: The 1-year and 2-year death-censored graft survival in the en bloc kidney transplantation (KTx) group was inferior to that in the single KTx group. Subgroup analysis of the single KTx group found that the 1-year and 2-year death-censored graft survival in the group where the donor BW was between 5 and 10 kg was 97.7 and 90.0%, respectively. However, graft survival was significantly decreased when donor BW was ≤5 kg (p < 0.01), mainly because of the higher rate of thrombosis (p = 0.035). In the single KTx group, the graft length was increased from 6.7 cm at day 7 to 10.5 cm at 36 months posttransplant. The estimated glomerular filtration rate increased up to 24 months posttransplant. Delayed graft function and urethral complications were more common in the group with BW was ≤5 kg. Conclusions: Our study suggests that single kidney transplantation from donors weighing over 5 kg to pediatric recipients is a feasible option for children with poor access to transplantation.
Nephrology Dialysis Transplantation, 2012
We hypothesized that supplementing a higher mass of renal parenchyma from adult donors, and their younger age, would improve graft function in paediatric recipients. We calculated estimated glomerular filtration rate (eGFR; Schwartz formula) and absolute glomerular filtration rate (absGFR) in 57 renal-grafted children (1995-2007) aged 3.1-17.9 years, weighing 12.9-85.0 kg, on discharge from the hospital after transplantation (TPL), 1 year after TPL and at the last follow-up (1.5-11.7 years after TPL). We correlated their eGFR with the individual ratio between the donor and the recipient body weight at the time of TPL (donor/recipient body weight ratio; D/R BWR), and we evaluated the effect of the donor and the actual recipient body weight on the eGFR and absGFR. The D/R BWR varied from 0.65 to 5.23. We found a significant positive correlation between D/R BWR and eGFR at discharge from the hospital (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), 1-year post-TPL (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and at the last follow-up (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Using multiple linear regression analyses, we found that both eGFR and absGFR values were much more determined by the actual recipient weight than by the donor weight (27/6% and 43/4% at discharge, by 24/4% and 57/0% 1 year after TPL, and 0/0% and 20/0% at the end of the follow-up). A tendency for lower eGFR with increasing age of donors was apparent at discharge and 1 year after TPL, but it reached statistical significance only at the last follow-up (r = 0.4254, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In paediatric renal transplants, the value of D/R BWR directly correlated with eGFR in the early and late posttransplant periods. However, this correlation was mainly influenced by the recipient weight, while the donor weight played only a minor or negligible role.