Renal Transplantation in Children 15 Kg or Less: The British Columbia Children’s Hospital Experience

PurposeSmall infants are the most challenging group of patients to undergo renal transplantation.PurposeWe reviewed the transplantation experience at our institution with children less than 15 kg at transplantation.Materials and MethodsWe retrospectively reviewed the records of 24 recipients in a 20-year period. Technical and allograft outcomes were compared to those in the North American Pediatric Renal Transplant Cooperative Study database.ResultsSince the inception of our program 24 recipients weighing 15 kg or less who were 6 years or younger have undergone transplantation. Seven grafts (29%) were from living donors. At transplantation mean age was 3.1 years (range 1.8 to 5.7) and mean weight was 13.4 kg (range 9.0 to 15.7). Average cold and warm ischemic times were 14.1 hours (range 3.4 to 37.2) and 23.1 minutes (range 21 to 41), respectively. Early complications were ureteral stricture requiring pyeloureterostomy in 1 case, reversible acute tubular necrosis in 2 and early arterial thrombosis salvaged by immediate thrombectomy in 1. Delayed complications were arterial stenosis requiring angioplasty in 2 cases, and 3 delayed deaths related to malignant hypertension in 2 and sepsis in 1. No grafts were lost due to thrombosis. Mean serum creatinine at years 1 to 3 and 5 were 48.5, 67.5, 79.1 and 84.4 μmol/l, respectively. Graft survival was 92% (22 patients after censoring 1 who died with a functioning graft) at 2 and 5 years. Overall results compare favorably to those in the North American Pediatric Renal Transplant Cooperative Study.ConclusionsWith a multidisciplinary team effort successful results can be achieved in this challenging group of patients.