PEDIATRICS

R.E. Kirby¹, S.E. Kennedy¹, A.R. Rosenberg¹, G. Kainer¹, J. Frawley², K. Haghighi^2
1Surgery, Sydney Children's Hospital, Sydney/NSW/AUSTRALIA, ²Department Of Surgery, Prince of Wales Hospital, Sydney/AUSTRALIA

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Introduction Kidney transplantation in small children with anatomically small iliac fossae is performed orthotopically using the peritoneal cavity. Our aim in this study was to evaluate the progress of paediatric patients who underwent orthotropic renal transplantation at our institution. Methods A retrospective analysis of all patients undergoing orthotopic renal transplantation at our institution was carried out. Paramaters that were analysed in all cases included age, weight, height, aetiology of renal failure, dialysis, prior surgery , co-morbidities as well as live versus cadaveric donation. Intra- operative fluids, blood loss, transfusion requirements, organ ischaemic time and duration of surgery were analysed. Post operative parameters included bladder complications and their management, HTN, lowest GFR, time at lowest GFR and we followed up GFR at 1/3/6/12/24/36/48 and 60 months in all applicable cases. Results From May 1987 to October 2009, 41 patients: 25 male (61%) and 16 female (39%) with ages ranging 1 to 17 years (median age 7 years), underwent orthotopic renal transplantation. All the remaining grafts are functional except one child who developed graft thrombosis postoperatively that requires retransplantation a year later and four that have been retransplanted in the iliac fossae as a result of chronic rejection. The second case of graft thrombosis was recognised introperatively and successful thrombectomy performed. There was one mortality in our series 2 days post transplantation. Conclusion Orthotopic renal transplantation is a safe and effective way of transplanting adult kidneys in small children.

Disclosure: All authors have declared no conflicts of interest.