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PREDICTIVE RISK FACTORS OF RENAL GRAFT LOSS IN CHILDREN UNDER 20 KG
Matthieu PEYCELON
1
, Marianna CORNET
1
, Annabel PAYE-JAOUEN
1
, Marie-Alice MACHER
2
, Julien HOGAN
2
, Arnaud
BONNARD
1
, Souhayl DAHMANI
3
, Jerôme NAUDIN
4
, Anca TANASE
5
, Christine GRAPIN-DAGORNO
6
and Alaa EL
GHONEIMI
1
1) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and
Urology, Paris, FRANCE - 2) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité,
Pediatric Nephrology, Paris, FRANCE - 3) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne
Paris Cité, Pediatric Anesthesiology, Paris, FRANCE - 4) Robert-Debré University Hospital, AP-HP; Université Paris
Diderot, Sorbonne Paris Cité, Pediatric Intensive Care Unit, Paris, FRANCE - 5) Robert-Debré University Hospital, AP-HP;
Université Paris Diderot, Sorbonne Paris Cité, Pediatric Radiology, Paris, FRANCE - 6) Robert-Debré University Hospital,
AP-HP; Université Paris 13, Sorbonne Paris Cité, Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
The aim of this study was to identify predictive risk factors of renal graft loss in children weighing less than 20 kg.
MATERIAL AND METHODS
Consecutive renal transplantations performed between 1994 and 2014 on children < 20kg were retrospectively
analyzed. Data included: patient characteristics (age, original pathology, preemptive nephrectomy, type of dialysis),
donor characteristics (living donor transplantation (LDT), donor to recipient weight ratio (DRWR), number of graft
vessels), intraoperative parameters (intravenous expansion, hemodynamics, ischemia time, routine Doppler ultrasound
after abdominal wall closure). Graft survival curve was generated. Statistical analysis: Fisher test.
RESULTS
Thirty-nine children received transplantation at median age of 41 months (18-125), median weight of 15 kg (8-20),
median DRWR of 3.85 (0.6-8). Median follow-up was 78 months (15-248). Twelve patients received related-LDT. One
patient was excluded because of lack of data. At five years, patient survival rate was 100% and graft survival rate was
91.3%. Three graft losses (7.9%) occurred due to arterial thrombosis in the first postoperative week. Association of
DRWR > 3.85 and multiple renal vessels was significantly associated with graft loss (p=0.04). The presence of only one
of these factors lead to one loss (4.5%) in 22 patients (ns). Five children with the association of DRWR > 3.85 and
multiple vessels had four (80%) allograft compartment syndroms (p=0.001). Two of them lost their graft while the two
remaining cases had a successful salvage procedure by abdominal wall closure using temporary Goretex plate.
CONCLUSIONS
The risk for graft loss is multifactorial. The association of high donor to recipient weight ratio and multiple vessels is a
significant risk factor for renal graft loss. If allograft compartment syndrom is diagnosed, a salvage abdominal closure
with Goretex plate may save the graft.