title: Surgical Complications in En Bloc Renal Transplantation.
abstract: En bloc pediatric transplantation (EBPT) began with the aim of increasing the donor pool due to the existing high demand for donors. At its inception, it was considered a type of suboptimal transplantation due to its association with a high incidence of vascular, urologic, and immunologic complications. The main objective of this study was to update information on EBPT with the largest case series that exists on a worldwide scale. In a retrospective study, the results obtained from brain-dead donors (BDDs; n = 770) were compared to those of EBPT (n = 100) from January 1990 to December 2012. The median of follow-up was 12.8 years (interquartile range 8.1 to 17.2). The variables collected for analysis were demographic factors (age and sex of recipients, age and weight of donors), renal function, graft survival, recipient survival, surgical complications (thrombosis, lymphocele, urologic complications, and renal artery stenosis and need for revascularization with angioplasty and/or stents). Subsequently in a second analysis, we studied the association between graft survival, thrombosis, angioplasty, stents, and appearance of lymphoceles with the different factors that were considered to be related in accordance with published literature and our own experience. Graft loss due to surgical complications was more frequent in EBPT than in BDD (15% vs 2.2 % in BDD; P < .001), and interstitial fibrosis and tubular atrophy were more frequent in BDD (13% vs 2%; P < .001). EBPT offers a good survival rate after overcoming the possible surgical complications that may arise.
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain. Electronic address: angie.moreno@gmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Moreno de la Higuera Díaz
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Calvo Romero
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Pérez-Flores
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Calvo Arévalo
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Rodríguez Cubillo
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Shabaka
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: López de la Manzanara
authors.affiliation: Urology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Gómez Vegas
authors.affiliation: Urology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Blázquez Izquierdo
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: A I
authors.initials: AI
authors.lastname: Sánchez-Fructuoso
mesh_terms: D000293:Adolescent; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008210:Lymphocele / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012078:Renal Artery Obstruction / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D014019:Tissue Donors / Q000600:supply & distribution