Pediatric KT in children up to 15 kg: A single‐center experience

Abstract

Background KT is the preferred treatment for ESRD in pediatrics. However, it may be challenging in those weighing ≤15 kg with potential complications that impact on morbidity and graft loss. Methods This retrospective review reports our experience in KT in children, weighing ≤15 kg, and the strategies to reduce morbidity and mortality. Results All patients were on RRT prior to KT. Patients reached ESRD mainly due to urologic malformations (54.54%). LD was performed in 82% of patients. The recipient's median age was 2.83 years, and median weight 12.280 kg. Male sex was predominant (73%). All patients required transfusions of PRBCs. There was a high requirement for ventilated support in patients post‐KT with no relation to weight, amount of resuscitation used intra‐operatively or ml/kg of PRBCs. One patient presented with stenosis of the native renal artery. No patients presented DGF, graft thrombosis, or surgical complications. No association was found between cold ischemia and eGFR at 1 year (p = .12). In univariate analysis, eGFR at 1 year is related to AR. eGFR at 3 years is related to the number of UTI. Median follow‐up was 1363 days. Patient and graft survival were 100%. Conclusions KT in children ≤15 kg can be challenging and requires a meticulous perioperative management and surgical expertise. Patient and graft survival are excellent with low rate of complications.

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

“…Finally, a total of 23 studies were included in this systematic review (Fig. 1) [9][10][11]12,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Changes in graft outcomes in recipients <10 kg over 25 years of pediatric kidney transplantation in the United States

“…Similarly, patient survival appeared to rapidly decline particularly in the <8.6 kg weight group in the immediate post‐transplant period. Several other single‐center studies have examined outcomes in children <15 kg 21–24 . Two studies comparing children <15 kg and those ≥15 kg showed that there was no difference in allograft outcomes based on weight at the time of transplant 22,24 .…”

“…Several other single-center studies have examined outcomes in children <15 kg. [21][22][23][24] Two studies comparing children <15 kg and those ≥15 kg showed that there was no difference in allograft outcomes based on weight at the time of transplant. 22,24 One study showed that recipients with a weight <15 kg at the time of transplant were associated with an increased occurrence of venous thrombosis.…”

Kidney transplants in small children: Weighing the pros and cons

“…Nevertheless, improvements in surgical methods and the refinement of skills have led to better transplant success rates in this young patient population. [11][12][13] In young children, meticulous management of intravascular volume is crucial both during surgery and in the immediate postoperative phase. Younger age at transplantation may increase the risk of viral infections due to incomplete immunization schedule, or because many infants are seronegative for CMV when they undergo transplantation.…”

“…Performing KT in infants involves technical difficulties owing to the small size of the recipient's blood vessels, the infant's lower blood pressure, and the significant mismatch in size between the typically adult‐sized donor kidney (which demands a substantial share of the child's heart output) and the small abdominal cavity of the infant. Nevertheless, improvements in surgical methods and the refinement of skills have led to better transplant success rates in this young patient population 11–13 . In young children, meticulous management of intravascular volume is crucial both during surgery and in the immediate postoperative phase.…”