Abstract
Aim: To compare the outcomes between low-weight (<15 kg) and normal-weight (>15 kg) children who underwent renal transplantation (RT) and investigate the impact of the surgical approach (intraperitoneal or extraperitoneal RT).
Material and Method: This study was designed as an observational single-centre study and was conducted in Istinye University Hospital, Istanbul, Turkey, between January 2018 and June 2021. Data including age, gender, weight, surgical approach (intraperitoneal/extraperitoneal), complications, length of hospital stay, graft and patient survival were collected. Low-weight (LW) and normal-weight (NW) patients were compared. A p value less than 0.05 was considered statistically significant.
Results: Overall, 107 (33 LW and 74 NW) patients aged between 1 and 17 were included. The LW group had a significantly lower age and a significantly longer duration of intensive care unit (ICU), and inpatient floor stays than the NW group (p<0.001). Intraperitoneal RT (IRT) was significantly more common in the LW group (57.6% vs 42.4%), while ERT was more frequent in the NW group (87.8% vs 12.2%) (p<0.001). Both early complication and mortality rates were significantly higher in the LW group than in the NW group (p<0.001 and p<0.031). A comparison between the LW and NW patients who underwent ERT revealed that the mean patient age was significantly lower, while the duration of ICU stay was higher in the former than in the latter group (p<0.001 and p<0.004). However, the length of inpatient floor stay, early-term complication, and mortality rates were similar (p>0.05).
Conclusion: The extraperitoneal approach should be encouraged in children weighing less than 15 kg.
References
- Gill JS, Rose C, Joffres Y, Landsberg D, Gill J. Variation in dialysis exposure prior to nonpreemptive living donor kidney transplantation in the United States and its association with allograft outcomes. Am J Kidney Dis 2018; 71: 636-47.
- Delmonico FL, Harmon WE. Pediatric kidney transplantation in the United States: the current realities. Am J Transplant 2008; 8: 2487-8.
- Saeed B. Pediatric renal transplantation. Int J Organ Transplant Med 2012; 3: 62-73.
- Shokeir AA, Osman Y, Ali-El-Dein B, El-Husseini A, El-Mekresh M, Shehab-El-Din AB. Surgical complications in live-donor pediatric and adolescent renal transplantation: study of risk factors. Pediatr Transplant 2005; 9: 33-8.
- Alam S, Sheldon C. Urological issues in pediatric renal transplantation. Curr Opin Urol 2008; 18: 413-8.
- Pillot P, Bardonnaud N, Lillaz J, et al. Risk factors for surgical complications after renal transplantation and impact on patient and graft survival. Transplant Proc 2012; 44: 2803-8.
- Wong-You-Cheong JJ, Grumbach K, Krebs TL, et al. Torsion of intraperitoneal renal transplants: imaging appearances. AJR Am J Roentgenol 1998; 171: 1355-9.
- Fangmann J, Oldhafer K, Offner G, Pichlmayr R. Retroperitoneal placement of living related adult renal grafts in children less than 5 years of age--a feasible technique? Transpl Int 1996; 9: S73-5.
- Muramatsu M, Mizutani T, Hamasaki Y, et al. Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience. Pediatr Transplant 2019; 23: e13401.
- Heap SL, Webb NJ, Kirkman MA, Roberts D, Riad H. Extraperitoneal renal transplantation in small children results in a transient improvement in early graft function. Pediatr Transplant 2011; 15: 362-6.
- Adams J, Güdemann C, Tönshoff B, Mehls O, Wiesel M. Renal transplantation in small children--a comparison between surgical procedures. Eur Urol 2001; 40: 552-6.
- Shenasky JH, Madden JJ, Smith RB. Retroperitoneal renal transplantation in young children. Urology 1975; 5: 733-6.
- Hata K, Ishida H, Ishizuka K, et al. Safe renal transplantation to the extraperitoneal cavity in children weighing less than 15 kg. Transplant Proc 2022; 54: 248-53.
- Raza S, Alahmadi I, Broering D, Alherbish A, Ali T. Kidney transplantation in low weight pediatric recipients from adult donors: The short- And the long-term outcomes. Pediatr Transplant 2021; 25: e13860.
- Tanabe K, Takahashi K, Kawaguchi H, Ito K, Yamazaki Y, Toma H. Surgical complications of pediatric kidney transplantation: a single center experience with the extraperitoneal technique. J Urol 1998; 160: 1212-5.
- Ghidini F, De Corti F, Fascetti Leon F, et al. Extraperitoneal kidney transplantation: a comparison between children weighting ≤15 kg and >15 kg. Experience of a single institution. Transpl Int 2021; 34: 2394-402.
- Chiodini B, Herman J, Lolin K, et al. Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study. Transpl Int 2018; 31: 720-8.
- Gander R, Asensio M, Royo GF, et al. Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome. J Pediatr Urol 2017; 13: 279.e1-279.e7.
- ElSheemy MS, Shouman AM, Shoukry AI, et al. Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less. J Pediatr Urol 2014; 10: 737-43.
- Nahas WC, Mazzucchi E, Scafuri AG, et al. Extraperitoneal access for kidney transplantation in children weighing 20 kg. or less. J Urol 2000; 164: 475-8.
- Vitola SP, Gnatta D, Garcia VD, et al. Kidney transplantation in children weighing less than 15 kg: extraperitoneal surgical access-experience with 62 cases. Pediatr Transplant 2013; 17: 445-53.
- Furness PD 3rd, Houston JB, Grampsas SA, Karrer FM, Firlit CF, Koyle MA. Extraperitoneal placement of renal allografts in children weighing less than 15 kg. J Urol 2001; 166: 1042-5.
Abstract
Amaç: Renal transplantasyon (RT) uygulanan düşük ağırlıklı (<15 kg) ve normal ağırlıklı (≥15 kg) çocuklar arasındaki sonuçları karşılaştırmak ve cerrahi yaklaşımın (intraperitoneal veya ekstraperitoneal RT) etkisini araştırmak. Gereç ve Yöntem: Bu çalışma gözlemsel tek merkezli bir çalışma olarak tasarlandı ve Ocak 2018 ile Haziran 2021 tarihleri arasında İstinye Üniversitesi Hastanesi, İstanbul, Türkiye'de gerçekleştirildi. Yaş, cinsiyet, kilo, cerrahi yaklaşım (intraperitoneal/extraperitoneal), komplikasyonlar, hastanede kalış süresi, greft ve hasta sağkalımı toplandı. Düşük kilolu (DK) ve normal kilolu (NK) hastalar karşılaştırıldı. 0.05'ten küçük bir p değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: 1 ile 17 yaşları arasında 107 (33 DK ve 74 NK) hasta dahil edildi. DK grubu, NK grubuna göre anlamlı olarak daha düşük bir yaşa ve anlamlı olarak daha uzun yoğun bakım ünitesi (YBÜ) ve hastane yatış süresine sahipti (p<0.001). İntraperitoneal RT (IRT) DK grubunda anlamlı olarak daha fazlaydı (%57,6'ya karşı %42,4), ERT ise NK grubunda (%87,8'e karşı %12,2) daha sıktı (p<0.001) . Hem erken komplikasyon hem de ölüm oranları DK grubunda NK grubuna göre anlamlı olarak yüksekti (p<0.001 ve p<0.031). ERT uygulanan DK ve NK hastalarının karşılaştırılması, ortalama hasta yaşının anlamlı olarak daha düşük olduğunu, yoğun bakımda kalış süresinin ise ikinci gruba göre daha yüksek olduğunu gösterdi (p<0.001 ve p<0.004). Ancak hastanede yatış süresi, erken dönem komplikasyon ve mortalite oranları benzerdi (p>0,05). Sonuç: 15 kg'ın altındaki çocuklarda ekstraperitoneal yaklaşım teşvik edilmelidir.
References
- Gill JS, Rose C, Joffres Y, Landsberg D, Gill J. Variation in dialysis exposure prior to nonpreemptive living donor kidney transplantation in the United States and its association with allograft outcomes. Am J Kidney Dis 2018; 71: 636-47.
- Delmonico FL, Harmon WE. Pediatric kidney transplantation in the United States: the current realities. Am J Transplant 2008; 8: 2487-8.
- Saeed B. Pediatric renal transplantation. Int J Organ Transplant Med 2012; 3: 62-73.
- Shokeir AA, Osman Y, Ali-El-Dein B, El-Husseini A, El-Mekresh M, Shehab-El-Din AB. Surgical complications in live-donor pediatric and adolescent renal transplantation: study of risk factors. Pediatr Transplant 2005; 9: 33-8.
- Alam S, Sheldon C. Urological issues in pediatric renal transplantation. Curr Opin Urol 2008; 18: 413-8.
- Pillot P, Bardonnaud N, Lillaz J, et al. Risk factors for surgical complications after renal transplantation and impact on patient and graft survival. Transplant Proc 2012; 44: 2803-8.
- Wong-You-Cheong JJ, Grumbach K, Krebs TL, et al. Torsion of intraperitoneal renal transplants: imaging appearances. AJR Am J Roentgenol 1998; 171: 1355-9.
- Fangmann J, Oldhafer K, Offner G, Pichlmayr R. Retroperitoneal placement of living related adult renal grafts in children less than 5 years of age--a feasible technique? Transpl Int 1996; 9: S73-5.
- Muramatsu M, Mizutani T, Hamasaki Y, et al. Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience. Pediatr Transplant 2019; 23: e13401.
- Heap SL, Webb NJ, Kirkman MA, Roberts D, Riad H. Extraperitoneal renal transplantation in small children results in a transient improvement in early graft function. Pediatr Transplant 2011; 15: 362-6.
- Adams J, Güdemann C, Tönshoff B, Mehls O, Wiesel M. Renal transplantation in small children--a comparison between surgical procedures. Eur Urol 2001; 40: 552-6.
- Shenasky JH, Madden JJ, Smith RB. Retroperitoneal renal transplantation in young children. Urology 1975; 5: 733-6.
- Hata K, Ishida H, Ishizuka K, et al. Safe renal transplantation to the extraperitoneal cavity in children weighing less than 15 kg. Transplant Proc 2022; 54: 248-53.
- Raza S, Alahmadi I, Broering D, Alherbish A, Ali T. Kidney transplantation in low weight pediatric recipients from adult donors: The short- And the long-term outcomes. Pediatr Transplant 2021; 25: e13860.
- Tanabe K, Takahashi K, Kawaguchi H, Ito K, Yamazaki Y, Toma H. Surgical complications of pediatric kidney transplantation: a single center experience with the extraperitoneal technique. J Urol 1998; 160: 1212-5.
- Ghidini F, De Corti F, Fascetti Leon F, et al. Extraperitoneal kidney transplantation: a comparison between children weighting ≤15 kg and >15 kg. Experience of a single institution. Transpl Int 2021; 34: 2394-402.
- Chiodini B, Herman J, Lolin K, et al. Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study. Transpl Int 2018; 31: 720-8.
- Gander R, Asensio M, Royo GF, et al. Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome. J Pediatr Urol 2017; 13: 279.e1-279.e7.
- ElSheemy MS, Shouman AM, Shoukry AI, et al. Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less. J Pediatr Urol 2014; 10: 737-43.
- Nahas WC, Mazzucchi E, Scafuri AG, et al. Extraperitoneal access for kidney transplantation in children weighing 20 kg. or less. J Urol 2000; 164: 475-8.
- Vitola SP, Gnatta D, Garcia VD, et al. Kidney transplantation in children weighing less than 15 kg: extraperitoneal surgical access-experience with 62 cases. Pediatr Transplant 2013; 17: 445-53.
- Furness PD 3rd, Houston JB, Grampsas SA, Karrer FM, Firlit CF, Koyle MA. Extraperitoneal placement of renal allografts in children weighing less than 15 kg. J Urol 2001; 166: 1042-5.
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| Primary Language | English |
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| Subjects | Health Care Administration |
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| Publication Date | March 27, 2023 |
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