Renal transplantation in children: critical analysis of age related surgical complications.
To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.
Irtan
S
S
Paediatric Surgery and Urology, Department of Paediatric Nephrology, Robert Debre Hospital, Paris, France. sabineirtan@aol.com
Maisin
A
A
Baudouin
V
V
Nivoche
Y
Y
Azoulay
R
R
Jacqz-Aigrain
E
E
El Ghoneimi
A
A
Aigrain
Y
Y
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult