A single center clinical experience in intensive care management of 104 pediatric renal transplantations between 1998 and 2002.
Only a few publications about the treatment in the intensive care unit (ICU) after pediatric renal transplantation have been published yet. As there are no guidelines, we hereby describe the results and recommendations of our transplant unit. A total of 104 renal transplantations have been performed in 96 children at our center since 1998. The age of the children has ranged from 6 months to 18 yr and their body weight from 6 kg to 110 kg. A special fluid management was performed in order to avoid hypotension and hypoperfusion of the graft. Systolic arterial pressure was kept at elevated levels above 100 mmHg during the first day after transplantation. The children remained on the respirator for 4-8 h after transplantation. Anticoagulation was performed using low dose heparin because of the size mismatch of the anastomosed vessels. The mean time in the ICU for the pediatric patients aged <3 yr was 2 days and for children older than 3 yr was 1 day. The main complications after renal transplantation in the ICU were disorders of electrolytes, acute renal failure because of a non-functioning graft (12%), bleeding from the anastomoses (4%), arterial or venous thrombosis (1%), arterial hypertension and pulmonary edema, defined as radiographic evidence (1%). In case of non-function peritoneal- or hemodialysis were performed in the ICU. Young children were more frequently affected than older children. From 1998-2002 one patient died during the ICU time. The 3 yr graft survival rate was 90%. To sum up, children undergoing renal transplantation should be treated in a specialized unit postoperatively to avoid early non-functioning of the graft and extrarenal complications. General guidelines for postoperative care should be established.
Department of Pediatric Nephrology, Medical School of Hannover, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. larspape@t-online.de
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Ehrich
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Sasse
D000293:Adolescent; D019072:Antibiotic Prophylaxis; D001795:Blood Pressure Determination; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007442:Intubation, Intratracheal; D016030:Kidney Transplantation; D008297:Male; D008991:Monitoring, Physiologic; D010146:Pain / Q000517:prevention & control; D016896:Treatment Outcome