Mesh hood fascial closure in renal allograft compartment syndrome in pediatric transplantation.

Abstract

INTRODUCTION Donor recipient organ size disparity remains a major obstacle in pediatric renal transplantation. Successful closure of the anterior abdominal wall in children following renal transplantation of adult organs may present as a challenging dilemma to transplant surgeons.(1) Renal Allograft Compartment Syndrome (RACS) is an under-appreciated and poorly described surgical complication of renal transplantation.(2) It occurs when a tight fascial closure compresses the graft in its limited retroperitoneal space leading to graft ischemia and resultant early renal allograft dysfunction.(2,3) Early renal allograft dysfunction may be caused by a number of technical factors including thrombosis, kinking of vessels, and a Page kidney situation in which allograft is compressed within a shallow false pelvis and limited retroperitoneal space.(4) The successful treatment requires a high index of suspicion, prompt recognition and early surgical decompression. To facilitate closure of the abdominal wall in these cases, a tension free technique using a polypropylene mesh is described. Mesh hood fascial closure (MHFC) was performed in two children, primarily to prevent graft loss due to RACS, and secondarily to treat this complication and avert incisional hernia.