Adv Pediatr Surg.  2021 Dec;27(2):67-72. 10.13029/aps.2021.27.2.67.

Kidney Transplantation in Children Weighing 15 kg or Less: Technical Challenges and Outcome in a Single Center

• Lee CH
• Oh C
• Lee S
• Lee O
• Lee KW
• Park JB

• KMID: 2525536
• DOI: http://doi.org/10.13029/aps.2021.27.2.67

Abstract

Purpose
Kidney transplantation (KT) in small children is known to be associated with increased risk of surgical complications that may potentially lead to graft loss. KT in children weighing 15 kg or less are considered to be most technically challenging. We present our transplant center's experience with KT in this cohort of children.
Methods
We retrospectively reviewed our transplant center's KT database from January 1994 to July 2019. Recipients’ and donors' data were collected for analysis.
Results
From January 1995 to July 2019, 69 cases of KT were performed in recipients ≤18 years. We identified 9 children (11.8%) who weighed ≤15 kg at the time of KT. There were 4 boys and 5 girls. Median age of recipients was 4.0 years (range 16 months–7 years). Median weight at KT was 14.0 kg (range, 11–15 kg). 3 cases were living-donor KT and 6 cases were deceased-donor KT. Median weight of the kidney allograft was 106 g (range, 65–235 g). The allograft was implanted intraperitoneally in 6 cases and extraperitoneally in 3 cases. Postoperative vascular complication occurred in 1 patient (arterial anastomosis stenosis). Graft loss occurred in 2 patients, due to renal artery stenosis and chronic allograft nephropathy. Graft survival was 88.9% and 88.9% at 1 and 5 years, respectively. Mean followup was 91.6 months. Graft survival of children who weighed ≤15 kg at the time of KT was not different compared to children who weighed more than 15 kg.
Conclusion
KT in small children weighing ≤15 kg is technically challenging. However, with comprehensive care by a pediatric transplant specialist, these challenges may be overcome and lead to good transplant outcomes.

Keyword

Kidney transplantation; Pediatric; Extraperitoneal; Intraperitoneal