SURGICAL COMPLICATIONS OF PEDIATRIC KIDNEY TRANSPLANTATION: A SINGLE CENTER EXPERIENCE WITH THE EXTRAPERITONEAL TECHNIQUE

Abstract

No AccessJournal of UrologyPotpourri1 Sep 1998SURGICAL COMPLICATIONS OF PEDIATRIC KIDNEY TRANSPLANTATION: A SINGLE CENTER EXPERIENCE WITH THE EXTRAPERITONEAL TECHNIQUE KAZUNARI TANABE, KOTA TAKAHASHI, HIROSHI KAWAGUCHI, KATSUMI ITO, YUICHIRO YAMAZAKI, and HIROSHI TOMA KAZUNARI TANABEKAZUNARI TANABE More articles by this author , KOTA TAKAHASHIKOTA TAKAHASHI More articles by this author , HIROSHI KAWAGUCHIHIROSHI KAWAGUCHI More articles by this author , KATSUMI ITOKATSUMI ITO More articles by this author , YUICHIRO YAMAZAKIYUICHIRO YAMAZAKI More articles by this author , and HIROSHI TOMAHIROSHI TOMA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62743-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The complex nature of pediatric renal transplantation and the often fragile condition of children with end stage renal disease create the potential for a number of complications. To decrease surgical complications we have performed renal transplantation via the extraperitoneal approach at our institution even in children who weigh less than 20 kg. We retrospectively evaluated whether renal transplantation via the extraperitoneal approach decreases surgical complications in pediatric kidney transplant recipients. Materials and Methods: From February 1983 to December 1996, 1,115 patients underwent renal transplantation at our institution, including 60 boys and 47 girls with a mean age of 11.9 years who comprise the study group. Mean weight was 30 kg. at transplantation, and 32 and 75 patients weighed less than 20 and 20 or more kg., respectively. All 107 patients were treated with cyclosporine or tacrolimus based immunosuppression, including methylprednisolone and azathioprine or mizoribine. Living related and cadaveric renal transplantation was performed in 92 and 15 cases, respectively. The extraperitoneal technique was performed in all recipients, even in low weight children. The aorta and inferior vena cava, common iliac artery and vein or hypogastric artery and external vein were used for vascular anastomosis depending on recipient size. The ureter was anastomosed to the bladder via a modification of Paquin's method or an extravesical technique. Results: During observation 7 surgical complications (6.5%) developed, including ureteral stricture, ureteral necrosis, renal artery stenosis, lymphocele, subcapsular hematoma, bladder leakage and significant vesicoureteral reflux to the graft in 1 patient each. There were no gastrointestinal complications. One patient with ureteral necrosis and 1 with subcapsular hematoma required surgical repair, and 1 underwent laparoscopic fenestration of a lymphocele. One patient with ureteral stricture and 1 with bladder leakage were treated conservatively, while another underwent ureteroneocystostomy. Overall only 1 graft (1%) was lost to a surgical complication (renal artery stenosis). Conclusions: The incidence of surgical complications of the extraperitoneal technique in pediatric renal transplant patients was low (6.5%) and seems to be acceptable. The extraperitoneal technique did not cause any gastrointestinal complications, which seems to be its greatest advantage. The extraperitoneal technique may be used safely even in low weight children. References 1 : Surgical perspectives in pediatric renal transplantation. In: . Chicago: Year Book Medical Pub.1991: 2301. chapt 62. Google Scholar 2 : Complications of surgical significance in pediatric renal transplantation. J. Ped. Surg.1992; 4: 485. Google Scholar 3 : Donor aortic cuff reduces the rate of anastomotic arterial stenosis in pediatric renal transplantation. J. Urol.1995; 154: 909. Link, Google Scholar 4 : Renal transplantation in children. Ped. Clin. N. Amer.1987; 34: 1209. Google Scholar 5 : Surgical aspects of renal transplantation: new approaches. Urol. Clin. N. Amer.1994; 21: 321. Google Scholar 6 : Factors influencing patient and graft surgical in 300 cadaveric pediatric renal transplants. J. Urol.1988; 140: 1129. Link, Google Scholar 7 : Renal transplantation into the dysfunctional bladder: the role of adjunctive bladder reconstruction. J. Urol.1994; 152: 972. Link, Google Scholar 8 : Pediatric renal transplantation into the abnormal urinary tract. Ped. Nephrol.1996; 10: 113. Google Scholar 9 : Renal transplantation in children following augmentation ureterocystoplasty. Urology1997; 50: 260. Google Scholar 10 : Characteristic aspects of vascular complications in renal transplantation in children. J. Rad.1994; 75: 57. Google Scholar 11 : Surgical aspects of transplantation: technique and complications. In: End Stage Renal Disease. Edited by . Philadelphia: W. B. Saunders Co.1984: 458. Google Scholar 12 : Laparoscopic drainage of a posttransplant lymphocele. Transplantation1991; 51: 725. Google Scholar From the Department of Urology and Pediatric Nephrology, Kidney Center, Tokyo Women's Medical College, Tokyo and Department of Urology, Niigata University, Niigata, Japan© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHarraz A, Shokeir A, Soliman S, El-Hefnawy A, Kamal M, Kamal A, El-Din A and Ghoneim M (2018) Toward a Standardized System for Reporting Surgical Outcome of Pediatric and Adolescent Live Donor Renal AllotransplantationJournal of Urology, VOL. 187, NO. 3, (1041-1046), Online publication date: 1-Mar-2012.FURNESS P, HOUSTON J, GRAMPSAS S, KARRER F, FIRLIT C and KOYLE M (2018) EXTRAPERITONEAL PLACEMENT OF RENAL ALLOGRAFTS IN CHILDREN WEIGHING LESS THAN 15 KG.Journal of Urology, VOL. 166, NO. 3, (1042-1045), Online publication date: 1-Sep-2001.LAPOINTE S, CHARBIT M, JAN D, LORTAT-JACOB S, MICHEL J, BEURTON D, GAGNADOUX M, NIAUDET P, BROYER M and RÉVILLON Y (2018) UROLOGICAL COMPLICATIONS AFTER RENAL TRANSPLANTATION USING URETEROURETERAL ANASTOMOSIS IN CHILDRENJournal of Urology, VOL. 166, NO. 3, (1046-1048), Online publication date: 1-Sep-2001.NAHAS W, MAZZUCCHI E, SCAFURI A, ANTONOPOULOS I, NETO E, IANHEZ L and ARAP S (2018) EXTRAPERITONEAL ACCESS FOR KIDNEY TRANSPLANTATION IN CHILDREN WEIGHING 20 KG. OR LESSJournal of Urology, VOL. 164, NO. 2, (475-478), Online publication date: 1-Aug-2000. Volume 160Issue 3 Part 2September 1998Page: 1212-1215 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information KAZUNARI TANABE More articles by this author KOTA TAKAHASHI More articles by this author HIROSHI KAWAGUCHI More articles by this author KATSUMI ITO More articles by this author YUICHIRO YAMAZAKI More articles by this author HIROSHI TOMA More articles by this author Expand All Advertisement PDF downloadLoading ...