Insights in Transplanting Complex Pediatric Renal Recipients With Vascular Anomalies. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Chandak, Pankaj; Kessaris, Nicos; Callaghan, Chris J.; Calder, Francis; Stojanovic, Jelena; Olsburgh, Jonathon; Drage, Martin; Hume-Smith, Helen; Ahmed, Zubir; Adamusiak, Anna; Roebuck, Derek; Forman, Colin; Marks, Stephen D.; Mamode, Nizam
• Is Part Of: Transplantation. Volume 101:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001640
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: 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. Methods: 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. Results: 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 2 ) of 43 to 72 (median, 55). Conclusions: 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. Abstract : Major vascular anomalies do not necessarily preclude renal transplantation in complex pediatric patients and that surgical exploration of the recipient prior to commencing the donor surgery is valuable where feasibility and safety are uncertain.