BERKELEY, CA (UroToday Inc.) - Surgical complications represent the most common difficulties after pediatric renal transplantation and may be associated with the greatest morbidity. The purpose of a recent study published in the February 2005 issue of Pediatric Transplantation was to report the surgical complications of pediatric and adolescent renal transplant recipients at Mansoura University in Egypt and to analyze the different factors that may influence the occurrence of such complications in a multivariate statistical method.

Shokeir and colleagues report on a total of 250 renal transplants performed in children and adolescents over a 25-year period. Of these patients, 154 were boys and 96 were girls with an overall mean age of 15.4 years. All patients received their kidneys from living donors and all grafts were harvested with traditional open surgical techniques. Ureteral anastomosis was established through a Lich-Gregoir extravesical technique in 213 patients and via a Politano-Leadbetter technique in 25 recipients. Ten patients underwent a uretero-ureteral anastomosis.

Analysis revealed that among the 250 patients, 35 surgical complications occurred in 33 patients. These complications included urinary leakage in 10 patients, ureteric stricture in 11 patients, complicated lymphocele in eight patients, hematoma necessitating surgical exploration in two patients, wound dehiscence in one patient, stone of the graft ureter in one patient and renal artery stenosis in two patients. The incidence of urological complications was 8.8% and vascular complications 0.8%. Neither graft nor patient survival was affected by the occurrence of surgical complications.

On univariate analysis, the factors that significantly affected the incidence of surgical complications were recipient's age (age > 10 had a higher incidence of complications), associated lower urinary tract abnormalities, the type of ureteral anastomosis, and the time to postoperative diuresis. On multivariate analysis, the type of primary urinary anastomosis was the only factor that reached statistical significance. The extravesical technique of Lich-Gregoir performed the best (albeit with a complication rate of 10.8 percent) while primary ureteral re-anastomosis was associated with a high rate of complications (40%).

In conclusion, the choice of ureteral reimplantation technique is the only risk factor that was found to affect the incidence of surgical complications among pediatric and adolescent live donor renal transplants, with the extravesical technique of Lich-Gregoir providing the best results in this study.

Pediatr Transplant. 2005 Feb; 9(1):33-8