Retroperitoneal kidney transplantation with liver and native kidney mobilization: a safe technique for pediatric recipients

被引:1
作者
Riella, Juliano [1 ,4 ]
Ferreira, Raphealla [4 ]
Tabbara, Marina M. [1 ]
Abreu, Phillipe [1 ,4 ]
Ernani, Lucas [1 ,4 ]
Defreitas, Marissa [3 ,4 ]
Chandar, Jayanthi [3 ,4 ]
Gaynor, Jeffrey J. [1 ,4 ]
Gonzalez, Javier [5 ]
Ciancio, Gaetano [1 ,2 ,4 ]
机构
[1] Univ Miami, Miller Sch Med, Dept Surg, Jackson Mem Hosp, Miami, FL 33136 USA
[2] Univ Miami, Miller Sch Med, Dept Urol, Jackson Mem Hosp, Miami, FL 33136 USA
[3] Univ Miami, Miller Sch Med, Dept Pediat, Div Nephrol,Jackson Mem Hosp, Miami, FL 33136 USA
[4] Univ Miami, Miller Sch Med, Miami Transplant Inst, Jackson Mem Hosp, 1801 NW 9Th Ave,7Th Floor, Miami, FL 33136 USA
[5] Hosp Gen Univ Gregorio Maranon, Unidad Trasplante Renal, Serv Urol, Madrid, Spain
关键词
Extraperitoneal approach; Liver and kidney mobilization; Pediatric kidney surgical technique; Transplantation; RENAL-TRANSPLANTATION; SINGLE-CENTER; CHILDREN; COMPLICATIONS; OUTCOMES; ALLOGRAFTS; THERAPY; RISK;
D O I
10.1007/s12519-022-00658-7
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BackgroundPediatric kidney transplant (KT) using larger, deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum. Liver and native kidney (L/NK) mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft. Here, we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization. MethodsWe retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups according to the surgical technique utilized: with L/NK mobilization (Group 1) and without L/NK mobilization (Group 2). Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Tests of association with the likelihood of using L/NK mobilization were performed using standard chi(2) tests, t tests, and the log-rank test. ResultsForty-six pediatric recipients were evaluated and categorized into Group 1 (n = 26) and Group 2 (n = 20). Recipients in Group 1 were younger (6.7 & PLUSMN; 0.8 years vs. 15. 3 & PLUSMN; 0.7, P < 0.001), shorter (109.5 & PLUSMN; 3.7 vs. 154.2 & PLUSMN; 3.8 cm, P < 0.001) and weighed less (21.4 & PLUSMN; 2.0 vs. 48.6 & PLUSMN; 3.4 kg, P < 0.001) than those in Group 2. Other baseline characteristics did not differ between Groups 1 and 2. One urologic complication was encountered in Group 2; no vascular or surgical complications were observed in either group. Additionally, no stents or drains were used in any of the patients. There were no cases of delayed graft function or graft primary nonfunction. The median follow-up of the study was 24.6 months post-transplant. Two patients developed death-censored graft failure (both in Group 2, P = 0.22), and there was one death with a functioning graft (in Group 2, P = 0.21). ConclusionsRetroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications, graft loss, or mortality.
引用
收藏
页码:489 / 501
页数:13
相关论文
共 36 条
  • [1] ACUTE TORSION OF A RENAL-TRANSPLANT - CAUSE OF ORGAN LOSS
    ABBITT, PL
    CHEVALIER, RL
    RODGERS, BM
    HOWARDS, SS
    [J]. PEDIATRIC NEPHROLOGY, 1990, 4 (02) : 174 - 175
  • [2] Extraperitoneal pediatric kidney transplantation of adult renal allograft using an en-bloc native liver and kidney mobilization technique
    Alameddine, Mahmoud
    Jue, Joshua S.
    Morsi, Mahmoud
    Gonzalez, Javier
    Defreitas, Marissa
    Chandar, Jayanthi J.
    Gaynor, Jeffrey J.
    Ciancio, Gaetano
    [J]. BMC PEDIATRICS, 2020, 20 (01)
  • [3] Bakir N, 1996, NEPHROL DIAL TRANSPL, V11, P140
  • [4] Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients
    Ciancio, Gaetano
    Farag, Ahmed
    Gonzalez, Javier
    Vincenzi, Paolo
    Gaynor, Jeffrey J.
    [J]. PLOS ONE, 2021, 16 (01):
  • [5] Favorable Outcomes With Machine Perfusion and Longer Pump Times in Kidney Transplantation: A Single-Center, Observational Study
    Ciancio, Gaetano
    Gaynor, Jeffrey J.
    Sageshima, Junichiro
    Chen, Linda
    Roth, David
    Kupin, Warren
    Guerra, Giselle
    Tueros, Lissett
    Zarak, Alberto
    Hanson, Lois
    Ganz, Susan
    Ruiz, Phillip
    O'Neill, William W.
    Livingstone, Alan S.
    Burke, George W., III
    [J]. TRANSPLANTATION, 2010, 90 (08) : 882 - 890
  • [6] Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey
    Dindo, D
    Demartines, N
    Clavien, PA
    [J]. ANNALS OF SURGERY, 2004, 240 (02) : 205 - 213
  • [7] Donor-Recipient Size Mismatch in Paediatric Renal Transplantation
    Donati-Bourne, J.
    Roberts, H. W.
    Coleman, R. A.
    [J]. JOURNAL OF TRANSPLANTATION, 2014, 2014
  • [8] Early Urologic Complications After Pediatric Renal Transplant: A Single-Center Experience
    Englesbe, Michael J.
    Lynch, Raymond J.
    Heidt, David G.
    Thomas, Susan E.
    Brooks, Melissa
    Dubay, Derek A.
    Pelletier, Shawn J.
    Magee, John C.
    [J]. TRANSPLANTATION, 2008, 86 (11) : 1560 - 1564
  • [9] Evidence to support a drain-free strategy in kidney transplantation using a retrospective comparison of 500 consecutively transplanted cases at a single center
    Farag, Ahmed
    Gaynor, Jeffrey J.
    Serena, Giuseppe
    Ciancio, Gaetano
    [J]. BMC SURGERY, 2021, 21 (01)
  • [10] Abdominal Compartment Syndrome: An Underrated Complication in Pediatric Kidney Transplantation
    Fontana, I.
    Bertocchi, M.
    Centanaro, M.
    Varotti, G.
    Santori, G.
    Mondello, R.
    Tagliannacco, A.
    Cupo, P.
    Barabani, C.
    Palombo, D.
    [J]. TRANSPLANTATION PROCEEDINGS, 2014, 46 (07) : 2251 - 2253