Does recipient weight and surgical approach really matter in pediatric renal transplantation?

Abstract

Aim: To compare the outcomes between low-weight (<15 kg) and normal-weight (>15 kg) children who underwent renal transplantation (RT) and investigate the impact of the surgical approach (intraperitoneal or extraperitoneal RT). Material and Method: This study was designed as an observational single-centre study and was conducted in Istinye University Hospital, Istanbul, Turkey, between January 2018 and June 2021. Data including age, gender, weight, surgical approach (intraperitoneal/extraperitoneal), complications, length of hospital stay, graft and patient survival were collected. Low-weight (LW) and normal-weight (NW) patients were compared. A p value less than 0.05 was considered statistically significant. Results: Overall, 107 (33 LW and 74 NW) patients aged between 1 and 17 were included. The LW group had a significantly lower age and a significantly longer duration of intensive care unit (ICU), and inpatient floor stays than the NW group (p<0.001). Intraperitoneal RT (IRT) was significantly more common in the LW group (57.6% vs 42.4%), while ERT was more frequent in the NW group (87.8% vs 12.2%) (p<0.001). Both early complication and mortality rates were significantly higher in the LW group than in the NW group (p<0.001 and p<0.031). A comparison between the LW and NW patients who underwent ERT revealed that the mean patient age was significantly lower, while the duration of ICU stay was higher in the former than in the latter group (p<0.001 and p<0.004). However, the length of inpatient floor stay, early-term complication, and mortality rates were similar (p>0.05). Conclusion: The extraperitoneal approach should be encouraged in children weighing less than 15 kg.

Keywords

• Renal transplantation
• Pediatric
• Low-weight
• Intraperitoneal
• Extraperitoneal

Abstract

Amaç: Renal transplantasyon (RT) uygulanan düşük ağırlıklı (<15 kg) ve normal ağırlıklı (≥15 kg) çocuklar arasındaki sonuçları karşılaştırmak ve cerrahi yaklaşımın (intraperitoneal veya ekstraperitoneal RT) etkisini araştırmak. Gereç ve Yöntem: Bu çalışma gözlemsel tek merkezli bir çalışma olarak tasarlandı ve Ocak 2018 ile Haziran 2021 tarihleri arasında İstinye Üniversitesi Hastanesi, İstanbul, Türkiye'de gerçekleştirildi. Yaş, cinsiyet, kilo, cerrahi yaklaşım (intraperitoneal/extraperitoneal), komplikasyonlar, hastanede kalış süresi, greft ve hasta sağkalımı toplandı. Düşük kilolu (DK) ve normal kilolu (NK) hastalar karşılaştırıldı. 0.05'ten küçük bir p değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: 1 ile 17 yaşları arasında 107 (33 DK ve 74 NK) hasta dahil edildi. DK grubu, NK grubuna göre anlamlı olarak daha düşük bir yaşa ve anlamlı olarak daha uzun yoğun bakım ünitesi (YBÜ) ve hastane yatış süresine sahipti (p<0.001). İntraperitoneal RT (IRT) DK grubunda anlamlı olarak daha fazlaydı (%57,6'ya karşı %42,4), ERT ise NK grubunda (%87,8'e karşı %12,2) daha sıktı (p<0.001) . Hem erken komplikasyon hem de ölüm oranları DK grubunda NK grubuna göre anlamlı olarak yüksekti (p<0.001 ve p<0.031). ERT uygulanan DK ve NK hastalarının karşılaştırılması, ortalama hasta yaşının anlamlı olarak daha düşük olduğunu, yoğun bakımda kalış süresinin ise ikinci gruba göre daha yüksek olduğunu gösterdi (p<0.001 ve p<0.004). Ancak hastanede yatış süresi, erken dönem komplikasyon ve mortalite oranları benzerdi (p>0,05). Sonuç: 15 kg'ın altındaki çocuklarda ekstraperitoneal yaklaşım teşvik edilmelidir.

Keywords

• Böbrek nakli
• Pediatrik
• Düşük kilo
• İntraperitoneal
• Ekstraperitoneal

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