Renal transplantation in children: Critical analysis of age related surgical complications

TLDR

Donor selection based on age is limited by organ shortage. The study aims to identify age‑related risk factors for urological and vascular complications in pediatric renal transplantation. The authors conducted a retrospective analysis of 202 renal transplantations in 193 children at a single institution from 1989 to 2007. Among 193 grafts, urological complications occurred in 21.7% (leading to graft loss in one case) and vascular complications in 13.9% (leading to graft loss in seven cases); donor age <6 years was a significant risk factor for vascular complications and graft loss, while posterior urethral valves increased urological complications; overall 5‑year patient and graft survival were 93.1 % and 84 %, with surgical complications accounting for 12 % graft loss and 38.9 % morbidity.

Abstract

To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.