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 create the potential for a number of complications. To decrease surgical complications we have performed renal transplantation via the extraperitoneal approach at our institution even in children who weigh less than 20 kg. We retrospectively evaluated whether renal transplantation via the extraperitoneal approach decreases surgical complications in pediatric kidney transplant recipients.

MATERIALS AND METHODS

From February 1983 to December 1996, 1,115 patients underwent renal transplantation 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 or more kg., respectively. All 107 patients were treated with cyclosporine or tacrolimus based immunosuppression, including methylprednisolone and azathioprine or mizoribine. Living related and cadaveric renal transplantation was performed in 92 and 15 cases, respectively. The extraperitoneal technique was performed in all recipients, even in low weight children. The aorta and inferior vena cava, common iliac artery and vein or hypogastric artery and external vein were used for vascular anastomosis depending on recipient size. The ureter was anastomosed to 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 artery stenosis, lymphocele, subcapsular hematoma, bladder leakage and significant vesicoureteral reflux to the graft in 1 patient each. There were no gastrointestinal complications. One patient with ureteral necrosis 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 conservatively, while another underwent ureteroneocystostomy. Overall only 1 graft (1%) was lost to a surgical complication (renal artery stenosis).

CONCLUSIONS

The incidence of surgical complications of the extraperitoneal technique in pediatric renal transplant patients was low (6.5%) and seems to be acceptable. The extraperitoneal technique did not cause any gastrointestinal complications, which seems to be its greatest advantage. The extraperitoneal technique may be used safely even in low weight children.