[Renal transplantation techniques in children with impaired patency of the inferior vena cava or iliac vein].
BACKGROUND
Congenital or acquired disorders of patency of the inferior vena cava (IVC) or iliac veins have been considered for a long time to be an almost insurmountable technical obstacle in paediatric renal transplantation. The authors report their experience based on 7 transplantations performed in children with a disorder of venous patency, in whom renal transplantation was able to be performed. More generally, they also discuss the available technical options based on a review of the literature.


METHODS
From April 1987 to January 2002, renal transplantation was performed in 7 children with congenital or acquired abnormality of the iliac veins or IVC in our unit. All children underwent radiological assessment by venous Doppler ultrasound before transplantation. The contribution of radiological examinations to the diagnosis, the surgical technique performed, postoperative complications, patient survival and graft survival as well as long-term renal function were studied retrospectively.


RESULTS
Four of the 7 transplanted children presented a congenital anomaly of the IVC and 3 had acquired thrombosis. In 5 out of 7 cases, the diagnosis was established before transplantation by Doppler ultrasound (completed by cavography in one case). The transplant renal vein was anastomosed to the iliocaval system in the majority of cases and the portal system had to be used in one case. With a mean follow-up of 94 months, all children have a functioning graft with a mean serum creatinine of 88 micromol/l.


CONCLUSIONS
Disorders of patency of the IVC or iliac veins in children waiting for renal transplantation are rare, but these abnormalities can cause problems for the surgical team and compromise graft survival. Radiological assessment of patency of the venous network must help to demonstrated these abnormalities in order to optimally adapt the transplantation technique, which ensures very acceptable graft survival rates.
Badet
Lionel
L
Service de Chirurgie et de la Transplantation et d'Urologie, Hôpital Edouard Herriot, Lyon, France. lionel.badet@chu-lyon.fr
Lezrek
Mohamed
M
Alves Saraiva
Walterdes
W
Cherasse
Arnaud
A
Pasticier
Gilles
G
Fassi Fehri
Hakim
H
Ranchin
Bruno
B
Cochat
Pierre
P
Colombel
Marc
M
Martin
Xavier
X
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007084:Iliac Vein; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000150:complications; D014654:Vascular Patency; D014682:Vena Cava, Inferior