SURGICAL COMPLICATIONS OF PEDIATRIC KIDNEY-TRANSPLANTATION - A SINGLE-CENTER EXPERIENCE WITH THE EXTRAPERITONEAL TECHNIQUE

Purpose: The complex nature of pediatric renal transplantation and the often fragile condition of children with end stage renal disease crea te the potential for a number of complications; To decrease surgical c omplications we have performed renal transplantation via the extraperi toneal approach at our institution even in children who weigh less tha n 20 kg. We retrospectively evaluated whether renal transplantation vi a the extraperitoneal approach decreases surgical complications in ped iatric kidney transplant recipients. Materials and Methods: From Febru ary 1983 to December 1996, 1,115 patients underwent renal transplantat ion at our institution, including 60 boys and 47 girls with a mean age of 11.9 years who comprise the study group. Mean weight was 30 kg. at transplantation, and 32 and 75 patients weighed less than 20 and 20 o r more kg., respectively. All 107 patients were treated with cyclospor ine or tacrolimus based immunosuppression, including methylprednisolon e and azathioprine or mizoribine. Living related and cadaveric renal t ransplantation was performed in 92 and 15 cases, respectively. The ext raperitoneal technique was performed in all recipients, even in low we ight children. The aorta and inferior vena cava, common iliac artery a nd vein or hypogastric artery and external vein were used for vascular anastomosis depending on recipient size. The ureter was anastomosed t o the bladder via a modification of Paquin's method or an extravesical technique. Results: During observation 7 surgical complications (6.5% ) developed, including ureteral stricture, ureteral necrosis, renal ar tery stenosis, lymphocele, subcapsular hematoma, bladder leakage and s ignificant vesicoureteral reflux to the graft in 1 patient each. There were no gastrointestinal complications. One patient with ureteral nec rosis and 1 with subcapsular hematoma required surgical repair, and 1 underwent laparoscopic fenestration of a lymphocele. One patient with ureteral stricture and 1 with bladder leakage were treated conservativ ely, while another underwent ureteroneocystostomy. Overall only 1 graf t (1%) was lost to a surgical complication (renal artery stenosis). Co nclusions: The incidence of surgical complications of the extraperiton eal technique in pediatric renal transplant patients was low (6.5%) an d seems to be acceptable. The extraperitoneal technique did not cause any gastrointestinal complications, which seems to be its greatest adv antage. The extraperitoneal technique may be used safely even in low w eight children.