Results of Kidney Transplantation in Small Children

Transplantation of small children is a challenging procedure which may be complicated by vascular thrombosis and significant hemodynamic changes and difficulty in abdominal wall closure. We sought to determine the results of our own experience at Schneider Children Medical Center Patient and Methods We extracted data from the hospital electronic files and our database on all children transplanted between 1/05-10/17. We looked at the patient and donor characteristics (age, weight, primary disease, type of donor (deceased or live), number of transplant. We excluded 9 patients undergoing combined liver-kidney transplantation. We defined small children as weight up to 13 kg and divided the donor group as donors > 13 years (normal size kidneys) and < 13 years (smaller kidneys). We compared vascular complication rate, graft and patient survival between the two groups of small children (GROUP 1) and larger children (GROUP 2). Results Of the 234 transplanted children 30 (12.7%) were small children-group 1 with a median age was 3.5 (1.5-8y) and median weight 11.4 (8-13kg). Eighteen children received a kidney from a deceased-donor and 12 from a live donor. Nineteen children received a kidney from donors age>13 and another 11 from children younger than 13y. The primary disease was: Congenital Renal dysplasia (18), FSGS (4), PKD (2) 6 (other). In group 1, 7/30 (23.3%) underwent intraperitoneal transplantation vs. 10/200 (5%) in group 2 (p<0.001). In the whole population 5 patients lost their graft for vascular thrombosis, one in group 1 and another 4 in group 2. There was no graft loss in group 1 secondary to abdominal compartment. The 1-5 and 10 year graft survival rates in group 1 and 2 were 93%,93%, 93% and 95%,86% and 74.6% for group 1 and 2 respectively (ns). In group 1 graft survival was better in children who received a kidney from a donors >13 years. Graft survival at 1-,5- and 10 years was slightly better in group 2 who received a graft from donors >13 y, 96.3%,86.6% and 75.4% vs. 90.1%, 83.5% and 70.3%, respectively (ns). Conclusions The results of kidney transplantation in small children are good. The rate of vascular complications are not increased and the use of a small kidneys in these children is associated with similar outcome as using larger kidneys.