title: Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome.
abstract: OBJECTIVE
  Pediatric kidney transplantation (KT) in small children is assumed to be related to potential surgical complications that may cause severe morbidity and graft loss. The aim of our study was to analyze the outcome of KT recipients weighing ≤15 kg, focusing on surgical complications, associated morbidity and mortality, as well as allograft loss.
  
  
  METHODS
  We reviewed our retrospective institutional database for recipients of KT between January 2000 and December 2014 with body weight ≤15 kg.
  
  
  RESULTS
  Forty-four children weighing ≤15 kg, out of a total of 164 children (26.8%), received a deceased donor KT at our center during the study period. Mean weight was 10.10 ± 2.9 kg (3-15 kg), and weight was ≤10 kg in 23 patients (52.3%). The allograft was implanted intraperitoneally in two cases (4.5%) and extraperitoneally in the remaining 42 (95.5%). Two patients received a simultaneous double liver-kidney transplant. Postoperative complications appeared in 10 patients (22.7%) and eight required reintervention. Five allografts (11.4%) were lost secondary to surgical complications. No statistically significant differences in surgical complications were observed when compared with patients weighing >15 kg. Actuarial graft survival was 81% and 73% at 1 and 5 years, respectively. No significant differences in graft survival were observed compared with patients >15 kg. Mean follow-up was 84.95 ± 50 months (1-190 months).
  
  
  CONCLUSIONS
  Our results demonstrate that KT in children weighing ≤15 kg is challenging but not associated with increased risk of surgical complications or early graft loss.
authors.affiliation: Division of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain. Electronic address: rgander@vhebron.net.
authors.forename: Romy
authors.initials: R
authors.lastname: Gander
authors.affiliation: Division of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Marino
authors.initials: M
authors.lastname: Asensio
authors.affiliation: Division of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Gloria Fatou
authors.initials: GF
authors.lastname: Royo
authors.affiliation: Division of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Jose Andrés
authors.initials: JA
authors.lastname: Molino
authors.affiliation: Division of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.affiliation: Division of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Luis Enrique
authors.initials: LE
authors.lastname: Lara
authors.affiliation: Division of Pediatric Surgery, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lloret
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Graft survival; Infants; Kidney; Pediatric kidney transplantation; Postoperative complications