Insights in Transplanting Complex Paediatric Renal Recipients With Vascular Anomalies

BACKGROUND: Children with end-stage kidney disease may have co-existing iatrogenic or congenital vascular anomalies making transplantation difficult. We describe our approach in 5 recipients with vascular anomalies and significant co-morbidities, including one case of blood group incompatibility. METHODS: Five children aged 3 - 17 (median 7) years, weighing 14 - 34 (median 18) kg of whom 4 had occluded inferior vena cava or iliac veins and 2 had previous complex vascular reconstructions prior to transplantation for mid-aortic syndrome and multiple aortic aneurysms, respectively underwent renal transplantation. In order to establish implant feasibility surgery was commenced in 2 recipients prior to the donor surgery. RESULTS: There was 4/5 (80 %) patient survival following one 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 (eGFR mls/min/1.73m) of 43 - 72 (median 55). CONCLUSIONS: We conclude that major vascular anomalies do not necessarily preclude transplantation in complex paediatric patients and that surgical exploration of the recipient prior to 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 paediatric transplantation.