title: Abdominal compartment syndrome: an underrated complication in pediatric kidney transplantation.
abstract: The transplantation of a large kidney in small children can lead to many complications, including an underrated complication known as abdominal compartment syndrome (ACS), which is defined as intra-abdominal pressure (IAP)≥20 mm Hg with dysfunction of at least one thoracoabdominal organ. Presenting signs of ACS include firm tense abdomen, increased peak inspiratory pressures, oliguria, and hypotension. Between June 1, 1985, and September 30, 2013, our center performed 420 kidney transplants (deceased/living related donors: 381/39) in 314 pediatric recipients (female/male: 147/167). ACS occurred in 9 pediatric patients (weight<15 kg) who received a large kidney from adult donors. In 1 case, the patient underwent abdominal decompression with re-exploration and closure with mesh in the immediate postoperative period. In a second case, the patient developed a significant respiratory compromise with hemodynamic instability necessitating catecholamines, sedation, and assisted ventilation. For small children transplanted with a large kidney, an early diagnosis of ACS represents a critical step. From 2005 we have measured IAP during transplantation via urinary bladder pressure, and immediately after wound closure we use intraoperative and postoperative duplex sonography to value flow dynamics changes. We recommend that bladder pressure should be routinely checked in small pediatric kidney recipients who are transplanted with a large graft.
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy. Electronic address: iris.fontana@hsanmartino.it.
authors.forename: I
authors.initials: I
authors.lastname: Fontana
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bertocchi
authors.affiliation: Anesthesiology and Intensive Care Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Centanaro
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Varotti
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Santori
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Mondello
authors.affiliation: Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tagliamacco
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cupo
authors.affiliation: General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Barabani
authors.affiliation: Department of Surgery, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Palombo
mesh_terms: D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016343:Monitoring, Intraoperative; D011312:Pressure; D001743:Urinary Bladder