Intraabdominal Complications Following Pediatric Kidney Transplantation: Incidence and Risk Factors

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The incidence and types of intraabdominal complications following pediatric transplantation are not well established and specific risk groups have not been clearly identified.


A retrospective chart review of all pediatric transplant recipients, between 1995 and 2016 was undertaken. Intraabdominal complications were grouped into 4 categories: fluid collections, gastrointestinal, vascular and urogenital. Donor, recipient, and transplant characteristics were evaluated using univariate and multivariate logistic regression.


There were 146 transplants meeting the inclusion criteria. The mean follow up time was 4.6 ± 3.7 years (range, 0.3-18). The mean weight at transplantation was 31.5 ±16.5kg (range, 9-78), with 24(16%) recipients being < 15kg and 23% under 5 years of age. Thirty-four (23%) patients had had previous abdominal surgery. There were 32 complications identified in 27 (18%) transplant recipients.


Fluid collections, requiring surgical drainage, developed in 9 (6.2%), gastrointestinal surgical complications in 12 (8.2%), vascular complications in 5 (3.5%) and urogenital complications in 6 (4.1%). There were only 3 graft losses due to abdominal complications, all following renal vein thrombosis.


Weight <15kg at the time of transplant (p=0.016), previous abdominal surgery (p=0.047) and intraperitoneal surgical technique (p=0.008) were risk factors in the univariate analysis using COX regression models, whereas only weight <15kg (p=0.003) and previous abdominal surgery (p=0.008) were retained in the multivariate analysis.


Intraabdominal complications occur in almost 1 in 5 pediatric renal transplant recipients. Weight <15kg and previous abdominal surgery are risk factors for developing such complications.

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