INTRODUCTION AND OBJECTIVES: Pediatric kidney transplantation is associated with various surgical complications due to the complexity of technique and often fragile condition of end-stage renal disease patients. To decrease complications, we performed renal transplantation using an extraperitoneal approach, even in children weighing less than 15 kg. We retrospectively evaluated the complications of renal transplantation to extraperitoneal cavity in pediatric renal transplant recipients.

METHODS: Between April 1983 and June 2016, 378 patients underwent renal transplantation in our pediatric nephrology department. Of these, 166 boys and 114 girls less than 16 years of age were enrolled in this study. The median age was 10.6 years, and weight was 23.3 kg at transplantation. Sixty patients weighed less than 15 kg (21%) and the median time on dialysis was 2.4 years. A total of 230 patients (82%) underwent living related renal transplantation, and 75 (27%) were ABO-incompatible cases. We performed the extraperitoneal technique in almost all pediatric patients, with 216 transplants placed in the iliac fossa with patient weight over 15 kg, and 64 transplants placed in a distal portion of the original lower renal pole with patient weight less than 15 kg.

RESULTS: Based on the Clavien-Dindo classification, there were 30 grade 2 cases (11%) and 14 grade 3 or higher cases (5%). There were no gastrointestinal complications. On logistic regression analysis, grade 2 or higher complications were significantly associated with weight less than 15 kg (p=0.027) and operative time longer than 245 minutes (p=0.0291). Of 49 patients who weighed less than 15 kg with an allograft placed in a distal portion of the original lower renal pole, only 3 (6%) surgical complications developed, including bladder hematoma, allograft rupture after declamping, and size mismatch between allograft and transplant space in 1 patient each.

CONCLUSIONS: Our study showed that the incidence of surgical complications with extraperitoneal technique was low (5%) and seems to be feasible. The technique of placing an allograft in the extraperitoneal cavity may be used safely in children weighing less than 15 kg.

CITATION INFORMATION: Hata K, Okumi M, Ishizuka K, Unagami K, Hirai T, Shimizu T, Omoto K, Ishida H, Hattori M, Tanabe K. Renal Transplantation to the Extraperitoneal Cavity in Children Weighing Less Than 15 kg Can Be Performed Safely. Am J Transplant. 2017;17 (suppl 3).

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