Surgical complications in live‐donor pediatric and adolescent renal transplantation: Study of risk factors

Shokeir, Ahmed A.; Osman, Yasser; Ali-El-Dein, Bedeir; El-Husseini, Amr; El-Mekresh, Mohsen; El-Din, Ahmed B. Shehab

doi:10.1111/j.1399-3046.2005.00244.x

Cited by 40 publications

(25 citation statements)

References 19 publications

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“…The pediatric patients from this cohort were later examined [35, 37] with no thromboses reported. This is unusual but could partly be due to selection of low risk donors between 21–60 years of age.…”

Section: Incidence Of Vascular Thrombosismentioning

confidence: 99%

Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Keller

Jørgensen

Jespersen

2012

Journal of Transplantation

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Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2–7.5% and venous thrombosis 0.1–8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this.

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Section: Incidence Of Vascular Thrombosismentioning

confidence: 99%

Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Keller

Jørgensen

Jespersen

2012

Journal of Transplantation

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“…In addition, superinfection of the lymphocele may occur (13). The diagnosis is made by ultrasonography, CT or MRI and confirmed by needle aspiration of the lymphocele content and measuring the creatinine concentration or finding lymphatic components (20–23). Prolonged wound drainage .…”

Section: Classification Of Wound Complicationsmentioning

confidence: 99%

Wound complications following kidney and liver transplantation

Mehrabi¹,

Fonouni²,

Wente³

et al. 2006

Clinical Transplantation

149

126

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Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.

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“…Urinary tract obstruction most commonly manifests within the 1st several postoperative months, although delayed manifestation can occur years after transplantation (48,54). The cause is related to ischemic anastomotic stricture at the ureteroneocystostomy in approximately one-half of the cases.…”

Section: Urinary Tract Obstructionmentioning

confidence: 99%

“…As a group, urologic complications are the most common cause of surgical morbidity in the pediatric transplant population, occurring in as many as 10% of patients, with a similar incidence regardless of age or body size (48,49). Most cases of urine leak and urinary tract obstruction occur in the 1st postoperative month.…”

Section: Urologic Complicationsmentioning

confidence: 99%

Imaging of Pediatric Renal Transplants and Their Complications: A Pictorial Review

Nixon¹,

Biyyam²,

Stanescu³

et al. 2013

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Renal transplantation is the treatment of choice for end-stage renal disease in children. As a technically demanding surgery with complex medical management, it is associated with a number of complications. Anatomic imaging including ultrasonography with color and spectral Doppler and functional assessment with renal perfusion scintigraphy are complementary for the detection and characterization of posttransplant complications. Complications can be characterized by the time of appearance after transplantation (immediate, early, or late) or the anatomic site of origin (perinephric, vascular, urologic, or renal parenchymal). Perinephric fluid collections include hematomas and seromas, abscesses, lymphoceles, and urinomas. Noninfected collections frequently resolve spontaneously but should be monitored to exclude progression. Vascular complications are more prevalent in pediatric patients because of the small vessel caliber and include vascular thrombosis and stenosis. Arteriovenous fistulas and pseudoaneurysms can complicate biopsy and are typically transient. Common urologic complications include urine leak and urinary tract obstruction. Renal perfusion scintigraphy can be invaluable in elucidating the nature of such complications. Renal parenchymal abnormalities include acute tubular necrosis, rejection, and toxic effects of medication. Imaging features of renal parenchymal abnormalities can overlap, and the primary role of imaging is to exclude alternative causes of renal dysfunction. Renal and nonrenal mass lesions are more common in immunosuppressed patients after transplantation. Familiarity with the normal imaging appearance of the renal allograft and the appearances of common complications facilitates accurate diagnosis and timely treatment, with the ultimate goal of increasing graft survival. This goal is particularly crucial in children, given their greater number of projected life years.

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Surgical complications in live‐donor pediatric and adolescent renal transplantation: Study of risk factors

Cited by 40 publications

References 19 publications

Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Wound complications following kidney and liver transplantation

Imaging of Pediatric Renal Transplants and Their Complications: A Pictorial Review

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