Search

Background We reviewed our experience with renal transplantation (RTx) in children weighing Methods Between 1987 and 2012, 68 RTx were performed in patients weighing less than 15 kg, including 17 with associated LUTD and 51 without. We detailed the lower urinary tract management in these patients, and compared graft survival rates and estimated clearance 12 and 60 months after RTx between groups. Results None of the patients without LUTD required any lower urinary tract surgery vs 8 out of 17 (47 %) with LUTD (p = 0.0001). The latter included a temporary incontinent urinary diversion in 5 cases (29 %), namely 2 vesicostomies and 3 cutaneous ureterostomies. After comparable follow-ups, there was no difference in patient survival, graft survival, and glomerular filtration rates between groups. Conclusions Provided that there is appropriate bladder management, a concomitant LUTD does not adversely influence the outcome of RTx in patients weighing less than 15 kg. However, 50 % of our patients required lower urinary tract reconstruction and, in 30 %, a temporary incontinent urinary diversion was placed at RTx, since lower urinary tract function could not be assessed reliably, the patient was not collaborative enough to be involved in a voiding program, and/or the RTx was prioritized., Author(s): Giulia Ghirardo[sup.1] , Paola Midrio[sup.2] , Pietro Zucchetta[sup.3] , PierGiorgio Gamba[sup.2] , GiovanniFranco Zanon[sup.2] , Luisa Murer[sup.1] , Marco Castagnetti[sup.4] Author Affiliations: (1) Paediatric Nephrology Unit, Department of Paediatrics, [...]

Background Near-infrared spectroscopy (NIRS) is a noninvasive technique designed to study regional oxygenation (rS[O.sub.2]) by measuring the absorption of chromophores. This study investigated the role of NIRS in the real-time monitoring of kidney graft perfusion for 72 h post-transplantation. Methods Consecutive children undergoing living related donor (LRD) or deceased donor (DD) kidney transplantation (KTP) were prospectively enrolled between April 2010 and August 2011. Renal rS[O.sub.2] values were registered continuously for 3 days and correlated with hourly urine output, serum creatinine, and urinary neutrophil gelatinase-associated lipocalin (u-NGAL). Results Twenty-four children were included, 6 underwent LRD and 18 DD KTP. Median age was 12.5 years (interquartile range [IQR] 3.5-16.6) and median body weight was 37 kg (IQR 13-49.7). Four patients experienced delayed graft function (DGF). Renal Doppler ultrasound showed normal vascularization patterns in all children. Median basal renal rS[O.sub.2] value was 68.8 % (IQR 59.3-76.2), significantly lower than the end-of-period result (83.6 %; IQR 79.2-90.4; p Keywords NIRS * Near-infrared spectroscopy * Renal transplantation * Pediatric renal transplantation * Delayed graft function, Introduction Renal transplantation may be burdened with a series of vascular or immunological complications that may present early in the postoperative period [1]. Thrombosis of the renal allograft vascular anastomosis [...]

Background Transplant renal artery stenosis (TRAS) is an increasingly recognised cause of post-transplant hypertension. Methods We retrospectively analysed 216 paediatric renal recipients transplanted between 2001 and 2011 to assess TRAS prevalence and percutaneous transluminal angioplasty (PTA) efficacy. To assess risk factors, we compared children with TRAS with a propensity score-matched cohort of recipients without TRAS. Results Of the 216 paediatric patients who were transplanted in the study period, 44 were hypertensive (prevalence 20.3%) and ten presented with TRAS (prevalence 4.6%, median age at transplantation 14 years, range 6.78-17.36 years). Hypertensive patients without TRAS were prescribed one to two antihypertensive agents, whereas patients with TRAS required one to five medications. In the TRAS group, one recipient presented with vascular complications during surgery, and in three patients the graft had vascular abnormalities. TRAS was detected by Doppler ultrasonography (US) performed due to hypertension in nine of the patients with TRAS, but in the tenth case the TRAS was clinically silent and detected by routine Doppler-US screening. TRAS diagnosis was refined using angio-computed tomography or angio-magnetic resonance imaging. All patients underwent PTA without complications. Significant improvement after PTA was observed in the standard deviation scores for blood pressure [3.2± 1.4 (pre-PTA) vs. 1.04±0.8 (post-PTA); p = 0.0006) and graft function [creatinine clearance: 69± 17.08 (pre-PTA) vs. 80.7± 21.5 ml/min/ 1.73 [m.sup.2] (post-PTA); p=0.006] We observed no significant differences between the two cohorts for cold ischaemia time, recipient/donor weight ratio, delayed graft function, cytomegalovirus infections and acute rejection episodes. Conclusions Our study reports a low but significant TRAS prevalence among the paediatric patients who were transplanted at our centre in the study period and confirms that PTA is an effective and safe therapeutic option in paediatric renal transplant recipients. Known risk factors do not appear to be related to the development of TRAS. Keywords Children * Renalartery stenosis * Transplantation * Kidney, Introduction Transplant renal artery stenosis (TRAS) is an increasingly recognised, potentially curable cause of refractory high blood pressure (BP) and allograft dysfunction. Its incidence varies from 1 to 23% in [...]