Introduction: Pediatric kidney transplants demand a high level of surgical and medical involvement and skill. In Norway, all organ transplants are centralized and performed at Oslo Univ. Hospital. Midline incision was our standard approach in all pediatric kidney recipients <25 kg and in all pediatric kidney recipients who underwent simultaneously bilateral nephrectomy. In May 2014 we adopted the retroperitoneal technique from Stanford Univ. Hospital (California, USA) for all our kidney recipients <25 kg in order to push the lower weight limit of the kidney recipient from 10 to 9 kg and to reduce postoperative intestinal paralysis and risk of ileus. Whenever simultaneously bilateral nephrectomy was done, it was previously performed via the midline incision, but with the “Stanford-technique”, it is now performed retroperitoneally via the right transplant incision and a separate left anterior incision.

Material and methods: From 2012 through December 1, 2017, a total of 54 pediatric (<18 years old) kidney transplants were performed in our center and 26 out of these 54 recipients were less than 25 kg. Out of the 26 below 25 kg, 14 were performed via midline incision, 9 with the Stanford approach. This data was investigated retrospectively.

Results:

Conclusion: The results post pediatric kidney transplants are exceptional, with 100% graft and patient survival with a mean follow up time of almost 3 years. The transition from midline approach to retroperitoneal (Stanford technique) approach has allowed for an approximately 1 kg lower minimum weight limit without any incidence of abdominal compartment syndrome and with a non-significant reduction in reoperation rate (p=0,63). This along with the retroperitoneal approach, JJ-ureter stent, and suprapubic bladder drainage is now being used more often. The Stanford technique with retroperitoneal approach for both kidney transplant and simultaneous nephrectomy in pediatric recipients <25 kg is safe and has resulted in an equally good outcome as midline approach.

CITATION INFORMATION: Horneland R., Khan A., Steinar G., Thorsen T., Hagness M. Pediatric Kidney Transplant in Norway – Results after Switching from Midline to Retroperitoneal Approach in Recipients below 25 kg Am J Transplant. 2017;17 (suppl 3).

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