Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up.

OBJECTIVES

To compare the haemorrhagic and vascular complications between paediatric and adult renal transplant recipients with a long-term follow-up.

PATIENTS AND METHODS

Between March 1976 and December 2006, in all, 1865 live-donor renal transplants were carried out. Patients were stratified according to their ages into two groups; paediatric (⩽18 years; 259) and adult (>18 years; 1606). Variables assessed included incidence, risk factors, management and sequelae of vascular and haemorrhagic complications. The effect of these complications on patient and graft survival was compared.

RESULTS

Haemorrhage requiring active intervention (percutaneous drainage or surgical exploration) was reported in seven children (2.7%) and 29 adults (1.8%), while thrombotic or stenotic complications were recorded in two children (0.77%) and 19 adults (1.18%; P < 0.05). Female gender, delayed onset of diuresis and acute tubular necrosis were significant predictors of vascular complications on univariate analysis, but none remained significant on multivariate analysis. In adults, vascular complications had a significant negative effect on mean (SD) 10-year graft survival compared to patients with no complications, at 19.8 (7.63)% vs. 55.7 (1.66)% (P = 0.01). Children who developed vascular complications had a significantly higher 5- and 10-year graft survival rate than adults (P = 0.01).

CONCLUSION

The incidence of vascular complications is comparable in paediatric and adult transplants. Vascular complications had a significant negative influence on graft survival in adult recipients. Children who developed vascular complications appear to tolerate its effects and have a better graft survival than have adults.