title: Insights in Transplanting Complex Pediatric Renal Recipients With Vascular Anomalies.
abstract: Children with end-stage kidney disease may have coexisting iatrogenic or congenital vascular anomalies making transplantation difficult. We describe our approach in 5 recipients with vascular anomalies and significant comorbidities, including one case of blood group incompatibility.
  
  
  
  Five children aged 3 to 17 years (median, 7 years), weighing 14 to 34 kg (median, 18 kg) kg of whom 4 had occluded inferior vena cava or iliac veins and 2 had previous complex vascular reconstructions before transplantation for midaortic syndrome and multiple aortic aneurysms, respectively underwent renal transplantation. To establish implant feasibility surgery was commenced in 2 recipients before the donor surgery.
  
  
  
  There was 4 (80%) of 5 patient survival after 1 death from sepsis (with a functioning graft) and 2 cases of delayed graft function. At the latest median follow-up of 19 months, there was 100% (death-censored) renal allograft survival with estimated glomerular filtration rates (mL/min per 1.73 m) of 43 to 72 (median, 55).
  
  
  
  We conclude that major vascular anomalies do not necessarily preclude transplantation in complex pediatric patients and that surgical exploration of the recipient before commencing the donor surgery is valuable where feasibility and safety are uncertain. In addition, we have developed a novel classification system of congenital vascular abnormalities and propose its use in complex pediatric transplantation.
authors.affiliation: 1 Department of Transplant Surgery, Guy's and Thomas', Evelina Children's London and Great Ormond Street Hospitals NHS Trust, London, United Kingdom. 2 Department of Paediatric Anaesthetics and Intensive Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 3 Department of Paediatric Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 4 Department of Vascular Surgery, Royal Free Hospital, London, United Kingdom. 5 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chandak
authors.forename: Nicos
authors.initials: N
authors.lastname: Kessaris
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Callaghan
authors.forename: Francis
authors.initials: F
authors.lastname: Calder
authors.forename: Jelena
authors.initials: J
authors.lastname: Stojanovic
authors.forename: Jonathon
authors.initials: J
authors.lastname: Olsburgh
authors.forename: Martin
authors.initials: M
authors.lastname: Drage
authors.forename: Helen
authors.initials: H
authors.lastname: Hume-Smith
authors.forename: Zubir
authors.initials: Z
authors.lastname: Ahmed
authors.forename: Anna
authors.initials: A
authors.lastname: Adamusiak
authors.forename: Derek
authors.initials: D
authors.lastname: Roebuck
authors.forename: Colin
authors.initials: C
authors.lastname: Forman
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D054079:Vascular Malformations / Q000150:complications*