Extraperitoneal placement of renal allografts in children weighing less than 15 kg.

Purpose: Extraperitoneal renal transplantation is not routine in small reci pients, in whom transperitoneal engraftment is the norm. The outcome of ext raperitoneal placement of renal allografts in children weighing less than 1 5 kg. was evaluated at 2 institutions. Materials and Methods: We retrospectively reviewed all pediatric renal tran splantations at 2 institutions from 1988 to 2000 and identified 29 children 14 to 72 months old (mean age 29.2) weighing less than 15 kg. (range 8 to 14.8, mean 11.2). All children underwent allograft placement extraperitonea lly via a modified Gibson and low midline retroperitoneal incision in 27 an d 2, respectively. A concurrent procedure was done via the same incision du ring 2 ipsilateral and 2 bilateral nephrectomies. Results: Of the 29 patients 25 have a functioning renal allograft. In 2 cas es the initial allograft; was lost due to early postoperative thrombosis an d acute rejection in 1 each, Two patients with a functioning allografts die d of medical complications greater than 2 years after transplantation. One child required reexploration secondary to fascial dehiscence and an additio nal recipient required pyeloureterostomy due to ureteral necrosis after liv ing related donor transplantation. Conclusions: Extraperitoneal renal transplantation is technically feasible in children who weigh less than 15 kg. This approach preserves the peritone al cavity, limits potential gastrointestinal complications and allows the c onfinement of potential surgical complications, such as bleeding and urinar y leakage. In addition, this approach provides complete access to the retro peritoneum to enable concurrent retroperitoneal. surgery, such as nephrecto my, to be performed safely. We recommend that extraperitoneal renal engraft ment should become routine in children weighing less than 15 kg. rather tha n using the more common transperitoneal approach for allograft placement.