[Characteristic aspects of vascular complications in renal transplantation in children].
In a series of 859 transplantations performed in children and adolescents from January 1973 to December 1992, vascular thrombosis accounted for 18% of all graft losses (2nd cause of graft failure), and 57% of early failures (within 2 months). Renal veins and arteries were equally affected. The young age of the donors and recipients constituted the main risk factor, thrombosis accounting for 40 and 37% respectively of all graft losses in donors and recipients < 5 years old. This explained the lower survival rate of these age groups after grafting, as reported in most published pediatric series. The prophylactic use of a low molecular weight heparin in high-risk grafts may help to decrease its incidence. A renal artery stenosis, located a few cm beyond the anastomosis in 2/3 of cases, was observed in 10% of grafts. Often severe hypertension (HBP) with cerebral complications, responsible for permanent sequelae in some cases, was the prominent symptom. Anti-hypertensive drug therapy was sufficient to control HBP in 40 cases out of 72, and in 10 of these, a spontaneous regression of the stenosis was remarked within a few months after repeated angiography. Transluminal angioplasty was used on 26 stenosis and was effective in 2/3 of cases; the recurrence rate, however, was 27%.
Gagnadoux
M F
MF
Service de Néphrologie Pédiatrique, Hôpital des Enfants-Malades, Paris.
Fontaine
E
E
Barthélemy
L
L
Brunelle
F
F
Revillon
Y
Y
Beurton
D
D
Broyer
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
Aspects particuliers des complications vasculaires dans la transplantation rénale de l'enfant.