Purpose:

Renal transplantation (RTx) of adult-sized kidneys leads to size-mismatch for small pediatric recipients. The aim of this study reveals the outcomes between intra- and extra-peritoneal RTx in low-weight pediatric recipients.

Methods:

We analyzed 49 pediatric patients weighting under 15kg who received a live-related donor RTx. The all patients were divided into two groups according to the approach of a transplant bed: intra-peritoneal approach (group A, n=23) and extra-peritoneal approach (group B, n=26). The correlation between recipient's weight and donor's weight (R-Wt/D-Wt) was analyzed. The time of initial urine, the surgical complications, estimated glomerular filtration rate (eGFR), graft survival and patient survival were estimated.

Results:

In group A, age, height and weight were 3.8±1.6 years old, 10.5±1.9kg and 84.9±6.4cm (group B: 4.9±1.9years old, 13.0±1.4kg and 95.1±7.5cm; p<0.05 in all). The correlation of R-Wt/D-Wt in all cases showed no relationship between both weights (p=0.062), but smaller children tended to receive a kidney from a low-weight donor. Weight of donor and pre-transplant donor kidney volume were equivalent in both groups (group A: 60.6±9.6kg, and 159.4±26.3ml, group B: 62.9±9.7 and 164.8±31.2ml). Single renal artery of graft was in 20 of group A and 15 of group B, and double renal arteries of graft was in 3 and 11. Of the cases with double renal arteries, 1 of group A and 6 of group B received ex-vivo reconstruction. The time of initial urine was 26.0 (13.0-53.0) mins in group A and 20 (12.0-38.5) mins in group B (p= 0.795). Posttransplant ileus was observed in 2 of group A and in 1 of group B. eGFR at 1week posttransplant in group A was significant higher than that in group B (group A 135.8±52.0, group B 109.5±29.4, p=0.035), then eGFR at 4 weeks posttransplant did not differ between both groups (group A 127.9±72.1, group B 103.2±27.4, p=0.117). There were no significant differences for 7-years patient and graft survival rate (group A 100% and 100%, group B 95.0% and 91.3%).

Conclusions:

The perioperative and long-term outcomes of pediatric RTx in small children were excellent. Adult-sized donor kidneys is acceptable for small pediatric recipients weighting under 15kg.

CITATION INFORMATION: Mizutani T., Muramatsu M., Hamasaki Y., Takahashi Y., Itabashi Y., Hashimoto J., Hyodo Y., Sakurabayashi K., Kawamura T., Shihido S. Intra- versus Extra-Peritoneal Approaches in Renal Transplantation of Adult-Sized Kidneys for Children Weighting under 15kg – A Single Center Study Am J Transplant. 2017;17 (suppl 3).

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