Long-term outcomes of living-donor kidney transplant children weighing less than 15 kg: Comparison of the surgical approach

Abstract

Kidney transplantation (KTx) is the most effective treatment for end-stage renal disease in children. We aimed to compare the long-term outcomes and surgical complications of the intraperitoneal approach (IPA) and extraperitoneal approach (EPA) for KTx in children weighing <15kg. We performed a retrospective cohort study on pediatric kidney transplant recipients, weighing <15kg, who received their first living-related kidney transplant between January 1987 and December 2015. Patients were divided into two groups based on the surgical approach (IPA or EPA) during transplant, and clinical data were extracted from the medical records. The median follow-up duration was 14.1 years (interquartile range, 9.0-19.2). Comparing the two groups (IPA group, n=62; EPA group, n=38), the median age and body weight were significantly lower in the IPA group (4.2 vs. 4.8 years, P=0.03; 11.7 vs. 13.0kg, P<0.01). There were 26 surgical complications (26%) in 19 patients during the follow-up period. The surgical complication rate was higher in the IPA group (39% vs. 6%). We assessed the long-term outcomes of the surgical approaches used for pediatric patients weighing <15kg who underwent KTx and received a size-mismatched adult donor kidney. There was no significant difference in renal transplantation prognosis using the surgical approach, but IPA-related complications were more frequent in the long term. Therefore, our data suggest that in cases of donor-recipient size mismatch in pediatric KTx, the EPA, associated with fewer surgical complications, is preferable to the IPA if the patient's body size has sufficient space for allograft placement. The transplant approach did not influence the long-term outcomes in children weighing <15kg, but EPA had fewer surgical complications and was technically safe.