Renal transplantation in small children--a comparison between surgical procedures.

Objectives: Renal transplantation is the therapy of choice for patients with end–stage renal failure. From the surgical point of view, small children remain a challenging patient group. Methods: We report our experience with 61 consecutive kidney transplantations in small children aged ≤6 years. Outcome and graft survival rates were presented with special reference to the surgical procedure used to perform the renal transplantation. Results: Of the 31 renal grafts, placed into the fossa iliaca (group 1), 8 grafts were lost shortly after transplantation due to a vascular complication (5 venous thromboses and 3 arterial thromboses). Six allografts were lost because of acute rejection. All in all, the 1– and 5–year graft survival rate in this group was 55.8% (p = 0.0106)/51.6% (p = 0.0134), respectively. Thirty grafts were placed retroperitoneally, using the aorta and the distal caval vein to perform end–to–side anastomoses (group 2). One graft was lost because of a venous thrombosis 6 weeks following transplantation, 3 further grafts were lost during the 1st year after transplantation due to acute rejection. The 1– and 5–year graft survival rate in that group was 86.6% (p = 0.0106)/83.3% (p = 0.0134), respectively. Comparing the 1–year graft survival rates of the two patient groups with special reference to vascular complications, we observed a 1–year graft survival rate of 74.2% (group 1) versus 96.6% (group 2; p = 0.026). Conclusions: Our results on kidney transplantation in small children have considerably improved with the consistent use of the aorta and the distal caval vein to perform vascular anastomoses. The number of vascular complications following renal transplantation decreased, and especially for very small children the retroperitoneal placement of the graft is a safe, feasible surgical procedure that should be performed whenever possible.