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EXTRAPERITONEAL ACCESS FOR KIDNEY TRANSPLANTATION IN CHILDREN WEIGHING 20 KG. OR LESS

2000; Lippincott Williams & Wilkins; Volume: 164; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(05)67403-4

1527-3792

William Carlos Nahas, Eduardo Mazzucchi, Ariel Gustavo Scafuri, Ioannis Antonopoulos, Elias David‐Neto, L E Ianhez, Sami Arap,

Pediatric Urology and Nephrology Studies

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Aug 2000EXTRAPERITONEAL ACCESS FOR KIDNEY TRANSPLANTATION IN CHILDREN WEIGHING 20 KG. OR LESS WILLIAM CARLOS NAHAS, EDUARDO MAZZUCCHI, ARIEL GUSTAVO SCAFURI, IOANNIS ANTONOPOULOS, ELIAS DAVID NETO, LUIS ESTEVAN IANHEZ, and SAMI ARAP WILLIAM CARLOS NAHASWILLIAM CARLOS NAHAS More articles by this author , EDUARDO MAZZUCCHIEDUARDO MAZZUCCHI More articles by this author , ARIEL GUSTAVO SCAFURIARIEL GUSTAVO SCAFURI More articles by this author , IOANNIS ANTONOPOULOSIOANNIS ANTONOPOULOS More articles by this author , ELIAS DAVID NETOELIAS DAVID NETO More articles by this author , LUIS ESTEVAN IANHEZLUIS ESTEVAN IANHEZ More articles by this author , and SAMI ARAPSAMI ARAP More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67403-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present our experience with kidney transplantation in children weighing 20 kg. or less. Surgery was done via extraperitoneal access while preserving the peritoneal cavity intact with special attention given to technical feasibility and the complication rate. Materials and Methods: Included in our study were 46 children with a median age of 7 years weighing 20 kg. or less (mean 16.6), of whom 16 weighed less than 15 kg. (median 13.2). The 25 boys and 21 girls underwent a total of 49 kidney transplants, including 2 in 3 during the study. Donors were living related in 44 cases and cadaveric in 5. Surgical access was obtained by making a J-shaped pararectal incision in a curvilinear fashion from the symphysis pubis to near the costal border. Results: Mean hospital stay was 22.9 days (range 6 to 83) and mean followup was 55.8 months (range 12 to 131). All patients received water on day 1 and food on day 2 postoperatively. In 6 patients 7 surgical complications developed, including urinary fistula in 2, superficial wound infection in 2 and vascular complications in 3 (renal vein thrombosis, stenosis and renal artery kinking in 1 each). Only 1 graft was lost due to a surgical complication. Conclusions: There are many advantages to using extraperitoneal access without an increase in surgical complications or technical difficulty. Absent gastrointestinal complications, an easier way to perform percutaneous biopsy, treatment of any surgical complication with no need for repeat laparotomy and the possibility of using the peritoneal cavity when dialysis is needed postoperatively are attractive justifications for extraperitoneal access. References 1 : Surgical complications after kidney transplantation in children. Transplant Proc1994; 26: 42. Google Scholar 2 : Surgical complications of pediatric kidney transplantation: a single center experience with the extraperitoneal technique. J Urol1998; 160: 1212. part 2. Link, Google Scholar 3 : Renal transplantation in children less than 5 years of age: a single center experience in the cyclosporine era. Transplant Proc1994; 26: 93. Google Scholar 4 : Transplanting adult kidneys into babies weighing less than 10 kg works. Transplant Proc1994; 26: 82. Google Scholar 5 : Renal transplantation in children less than two years old. Transplantation1997; 63: 554. Google Scholar 6 : Twenty-five years’ experience with renal transplantation in children of low socioeconomic class. Transplant. Proc1994; 26: 81. Google Scholar 7 : Renal transplantation in very young children. Aust N Z J Surg1995; 65: 637. Google Scholar 8 : Complicações cirúrgicas de 78 transplantes renais em crianças. J Bras Urol1997; 23: 141. Google Scholar 9 : CSA/AZA, in the absence of prednisone improves linear growth in renal transplanted children. Transpl Int1992; 5: S3. Google Scholar 10 : Do steroids matter in one-haplotype pediatric renal allograft recipients on cyclosporine/azathioprine?. Transplant Proc1994; 26: 95. Google Scholar 11 : Percutaneous needle biopsy of the renal allograft using the automated needle system: evaluation of 87 procedures. J Urol1993; 150: 313. Google Scholar 12 : Characteristic aspects of vascular complications in renal transplantation in children. J Radiol1994; 75: 57. Google Scholar 13 : Superior outcomes in pediatric renal transplantation. Arch Surg1997; 132: 842. Google Scholar 14 : Renal transplantation, chronic dialysis and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol1997; 11: 49. Google Scholar 15 : Complications of surgical significance in pediatric renal transplantation. J Pediatr Surg1992; 4: 485. Google Scholar 16 : Surgical aspects of renal transplantation: new approaches. Urol Clin North Am1994; 21: 321. Google Scholar 17 : Kidney transplantation in patients with bladder augmentation: surgical outcome and urodynamic follow-up. Transplant Proc1997; 29: 157. Google Scholar From the Unidade de Transplantes Renais do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByNahas W, Antonopoulos I, Piovesan A, Pereira L, Kanashiro H, David-Neto E, Ianhez L and Srougi M (2018) Comparison of Renal Transplantation Outcomes in Children With and Without Bladder Dysfunction. A Customized Approach Equals the DifferenceJournal of Urology, VOL. 179, NO. 2, (712-716), Online publication date: 1-Feb-2008.FURNESS P, HOUSTON J, GRAMPSAS S, KARRER F, FIRLIT C and KOYLE M (2018) EXTRAPERITONEAL PLACEMENT OF RENAL ALLOGRAFTS IN CHILDREN WEIGHING LESS THAN 15 KG.Journal of Urology, VOL. 166, NO. 3, (1042-1045), Online publication date: 1-Sep-2001. Volume 164Issue 2August 2000Page: 475-478 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordssurgical anastomosisperitoneumkidney transplantationperitoneal dialysis, continuous ambulatorykidneyMetricsAuthor Information WILLIAM CARLOS NAHAS More articles by this author EDUARDO MAZZUCCHI More articles by this author ARIEL GUSTAVO SCAFURI More articles by this author IOANNIS ANTONOPOULOS More articles by this author ELIAS DAVID NETO More articles by this author LUIS ESTEVAN IANHEZ More articles by this author SAMI ARAP More articles by this author Expand All Advertisement PDF DownloadLoading ...