Korean J Transplant.  2022 Nov;36(Supple 1):S252. 10.4285/ATW2022.F-3921.

Excellent outcomes in living-related kidney transplantation in children 15 kg or less: experience from a tertiary pediatric referral center in Singapore

• Koh ZJ
• Nyo YL
• Teo S
• Lau P
• Lee YY
• Loh DL
• Ng KH
• Yap HK
• Mali V

• KMID: 2535469
• DOI: http://doi.org/10.4285/ATW2022.F-3921

Abstract

Background
Despite significantly improved outcomes in pediatric renal transplantation (RT), there remain challenges for children weighing 15 kg or less; with consequently higher risks of complications and graft loss. Especially for smaller pediatric recipients of adult-donor kidneys, we aim for optimal renal perfusion by emphasizing meticulous technique for vascular anas-tomoses; together with aggressive volume support in the living-donor and recipient.
Methods
The medical records of 10 pediatric kidney recipients <15 kg at transplant (eight living-related donors) between 1989 and 2020 were retrospectively reviewed.
Results
Overall, the median age and weight at transplant were 56.5 months (IQR, 44.8–68) and 12.9 kg (IQR, 12.2–14.2) respectively. There were nine children who received pretransplant dialysis over a median duration of 26 months (IQR, 13–40). The surgical approach was either transperitoneal (n=6) or retroperitoneal (n=4) with the vascular anastomoses being to the aorta/ inferior vena cava (n=7), common iliac vessels (n=2) or splenic vessels (n=1). One child developed early vascular thrombosis requiring graft nephrectomy (day 4). None of the remaining children developed delayed graft function. Delayed complications were BK virus nephropathy (n=1, progressive graft failure 6 months posttransplant requiring resumption of dialysis and eventu-al re-transplantation at age/weight of 79 months and 19.5 kg respectively) and ureteric stricture (n=1, requiring revision ureteroureterostomy at five years posttransplant). Graft survival at 1-year and 2-years was 90% and 80% overall; and was 100% and 87.5% for living-related grafts respectively. Nine children have functioning grafts to date; over a median follow-up period of 14 years (IQR, 6–19.5). The mean creatinine levels were 83.5±35.3 umol/L at last follow-up.
Conclusions
Living-related kidney transplantation in children 15 kg or less may be safely performed in experienced pediatric centers with excellent short-term and long-term outcomes.