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Article Type

Original Study

Abstract

Objectives The aim of the study was to evaluate the operative and early postoperative surgical complications of renal transplantation in pediatric recipients. Background Renal transplantation is considered the treatment of choice in children with end-stage renal disease; however, it is still associated with several surgical complications. Patients and methods From July 2010 to January 2013, 50 consecutive pediatric kidney transplants were studied. Immediately before transplantation, a thorough history and physical examination with appropriate laboratory and radiological evaluation were performed to search for any medical or surgical problems that contraindicate the transplantation. We removed the kidney from a living donor through an open surgical technique. The kidney graft was placed extraperitoneally in the right iliac fossa. The arterial anastomoses were performed to the lower aorta or right common iliac artery. The venous anastomoses were performed to the lower inferior vena cava or the right common iliac vein. Our ureteral reimplantation technique was an extravesical, Lich-Gregoir technique. A ureteral stent was placed. We evaluated the ischemia time and any intraoperative or postoperative surgical complications. Results Our patients included 36 boys (72%) and 14 girls (28%). Kidneys came from live-related donors in all cases (27 mothers, 19 fathers, two aunts, one uncle, and one brother). At transplantation, the mean recipient age was 9.9 years (range 3-17 years) and mean body weight was 20.9 kg (range 11-45 kg). The graft was placed in an extraperitoneal position in the right iliac fossa in all cases (100%). In cases of single arterial anastomoses (94%), the mean ischemia time was 53.51 ± 11.68 min. In cases of double arterial anastomoses (6%), the mean ischemia time was 68.33 ± 5.77 min. There was significant association between single or double arterial anastomosis and ischemia time, where double arterial anastomosis had longer ischemia time (P = 0.004). There was no intraoperative surgical complication in most of our patients (98%) except in one case (2%) in which the kidney has been transplanted upside down due to misdirection of the upper pole from the lower pole of the kidney. Postoperatively, there were no surgical complications in most of our patients (92%), but there were three cases with high debit urine leaks (6%), and unfortunately there was a case of graft renal vein thrombosis (2%). The mean serum creatinine at 6 months post-transplant was 0.6 mg/dl (range 0.4-0.9 mg/dl). There were no cases of hyperacute rejection. All donors are alive with a good renal function after first 6 months postoperatively. Conclusion Our initial surgical experience with renal transplantation carried a low (but clinically significant) risk for vascular and urological recipient complications that increased morbidity, but improvements in our surgical techniques and experience decreased these complications.

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