Insights in Transplanting Complex Pediatric Renal Recipients with Vascular Anomalies

Pankaj Chandak, Nicos Kessaris, Chris J. Callaghan, Francis Calder, Jelena Stojanovic, Jonathon Olsburgh, Martin Drage, Helen Hume-Smith, Zubir Ahmed, Anna Adamusiak, Derek Roebuck, Colin Forman, Stephen D. Marks, Nizam Mamode

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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 m2) 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.

Original languageEnglish (US)
Pages (from-to)2562-2570
Number of pages9
JournalTransplantation
Volume101
Issue number10
DOIs
StatePublished - Oct 1 2017

Bibliographical note

Funding Information:
The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre awards to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King’s College Hospital NHS Foundation Trust and

Funding Information:
The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre awards to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust and Great Ormond Street Hospital for Children NHS Foundation Trust in partnership with University College London.

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc.

Fingerprint

Dive into the research topics of 'Insights in Transplanting Complex Pediatric Renal Recipients with Vascular Anomalies'. Together they form a unique fingerprint.

Cite this