Introduction: To avoid low output syndrome (LOS) and delayed graft function (DGF), precise intraoperative hemodynamic monitoring are mandatory for small pediatric recipients with adults' donor kidneys. We have evaluated the intraoperative fluid management under transesophageal echocardiography (TEE) monitoring for pediatric recipients with less than 15kg body weight.

Patients and Methods: Among 41 pediatric renal transplantations in our institute between 2008 and 2016, the recipients with body weight less than 15kg were eligible to use TEE for monitoring the maximum and safety hydration status during the operation. All grafts are from living related adult donors and transplanted by retroperitoneal approach. Intraoperative infusion was controlled to achieve more than 15mmHg in CVP just before graft reperfusion, and equivalent or 80% of donor's blood pressure. Early graft function and amount of intraoperative crystalloid/colloid/transfusion were compared between the recipients body weight less than 15kg (Group1;n=13) and body weight between 15 and 25kg (Group2;n=8).

Results: 13 recipients in Group 1, 11.3 (9.1-14.8) kg in body weight and 5.1(2-11) years in age, showed immediate function, and eGFR at POD1 and POD2 revealed 86.0 and 116.3ml/min/1.73m². Total amount of infusion before graft reperfusion was comparable between Group1 and Group2 (38±14 vs. 29±12ml/kg/hr). The volume of colloid/red blood cell transfusion infusion were significantly increased in Group1(13.5±7.7 and 5.5±2.7ml/kg/hr) compared with Group2 (6.0±4.7 and 1.9±1.8, P<0.05) to obtain the targeted hemodynamic parameters respectively. Interestingly, no significant decrease between pre and post graft reperfusion CVP (16.5±3.9 and 14.2±3.9mmHg) was observed in Group1 and Group2. None of the recipients required post-transplant hemodialysis and developed heart failure or severe pulmonary edema.

Conclusions: Intraoperative TEE monitoring in pediatric renal transplantation with small weight recipients allows more vigorous fluid management with colloid and red blood cell transfusion, which will avoid LOS and DGF after transplantation with adult' kidneys.

CITATION INFORMATION: Watarai Y, Narumi S, Kimura R, Hatazoe K, Okada M, Futamura K, Yamamoto T, Hiramitsu T, Tsujita M, Goto N, Goto Y. Intraoperative Fluid Management During Pediatric Kidney Transplantation with Less Than 15kg Body Weight Using Transesophageal Echocardiaography as Hemodynamic Parameter. Am J Transplant. 2017;17 (suppl 3).

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