Pediatric Renal Transplantation in Children with Weight 20kg or Less: A Single-Center Experience

Background: Renal transplantation (RT) is the treatment of choice for children with Chronic Kidney Disease (CKD). This technique benefits survival and quality of life. Long-term outcomes in pediatric transplantation have significantly improved over the past 20 years; however, children less than 5 years of age weighing 20 kg or less still remain a considerable challenge, with higher mortality rate and graft loss. Methods: In this article, we present the pediatric RT experience at Hospital Universitario de Cruces, the main center for transplants in Spain. Children who underwent RT within the period of January 2012 - January 2017 were retrospectively reviewed to identify those with weight less than 20 Kg. The following parameters were collected: pre-transplant characteristics, surgical technique, anesthesia characteristics, intra-operative and post-operative surgical or medical complications, pre and post-transplant creatinine levels, renal graft survival, and late post-operative complications. Results: Within a period of 5 years, a total of 13 pediatric patients (weight ≤ 20kg) underwent RT at Hospital Universitario de Cruces. The patient sample represented 37.14 % of the 35 renal transplants performed on pediatric patients at this institution. All 13 patients received a standard surgical and anesthetic perioperative management. Post-transplant creatinine levels significantly decrease after surgery during the early postoperative period from 6.45 mg/dl preoperatively (range, 1.90 - 12.26) to 0.59 mg/dl postoperatively (range, 0.27 - 1.27). The mean follow-up period was 1.5 year (range, 1 - 3) with 12 patients out of 13 (92.31%) presenting with 1-year graft survival. Conclusions: A multidisciplinary collaboration, including surgeons, nephrologists, and anesthesiologists specialized in handling transplants for underweight children should be a priority. Close intraoperative monitoring of vital signs and optimal fluid therapy is essential for anesthetic management due to the possible perioperative hemodynamic changes.