Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience.

Abstract

RTx of adult-size kidneys presents a size mismatch in small pediatric recipients, and there are potential surgical complications. This study reveals the outcomes of intra- and extraperitoneal RTx in low-weight (less than 15kg) pediatric recipients. We studied 51 pediatric patients weighing less than 15kg who received a living-related donor renal transplant between 2009 and 2017. The intraperitoneal (group A, n=24) and extraperitoneal (group B, n=27) approaches were compared. In group A, the mean age, Ht, and weight were 3.8±1.6years, 83.7±6.5cm, 10.5±1.8kg; in group B, 5.0±1.9years, 95.3±7.3cm, and 13.0±1.4kg. Single renal artery grafts (21 in group A and 16 in group B) and double renal artery grafts (three in group A and 11 in group B) were performed. Of the patients with double renal artery transplants, one in group A and six in group B underwent ex vivo arterial reconstruction. The eGFR (mL/min/1.73m2 ) at 1-week post-transplant in group A was significantly higher than that in group B; the eGFRs at 4weeks post-transplant did not differ. One graft was lost in group B because of vascular thrombosis. Post-transplant complications included ileus and transplant ureteral stenosis. There was no significant difference in 5-year graft survival rate (group A 100%, group B 91.7%). Both transplant approaches are feasible to adapt to a size mismatch between the adult-size donor kidney and low-weight pediatric recipients.