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Abstract
Most diseases that result in persistent compromise of renal function in children are progressive and lead to chronic renal failure. For well-being, rehabilitation and freedom from dependence on a machine, renal transplantation is considered the best available treatment for children. The alternative of dialysis is often made difficult by problems of access, growth retardation and renal osteodystrophy.
In this study 50 paediatric and adolescent patients underwent kidney transplantation and were thoroughly studied. Midline transperitoneal approach to create enough space for the adult kidney was needed in 22% of our study population. Ureteral stents were needed in 22% of patients. The 3 year patient and graft survival were very impressive (96% and 85.3% respectively). Multiple pre transplant urological procedures were needed to prime these patients for the transplant operation. Nevertheless the surgical and medical complication rate was relatively low (10% and 28% respectively).
In conclusion, for a successful transplant operation, careful pre-operative preparation is of great importance. Many of the children will have abnormal urinary tracts when put on the waiting list for a transplant. Careful evaluation by a paediatric urologist is needed with the performance of procedures that will ensure adequate urine emptying and preservation of the future graft function. Careful living donor evaluation and the emphasis on choosing young cadaveric donors with perfect body homeostasis at the time of donation is of immense importance. Attention to the basic principals of surgery is the best prevention to complications. Adequate exposure of the surgical field including the use of generous midline transperitoneal approach in the very small child will certainly make the operation technically easier. Adopting the basic principals of vascular surgery will help to prevent complications as vascular thrombosis. Judicious use of indwelling ureteral stents and substaining from the use of wound drain help to reduce the overall complication rate.
Postoperatively adequate immunosuppression and the provision of age appropriate clinical care will preserve patient life and graft. The provision of antibiotics, antifungal and antiviral medications in the post transplant period when needed will save the lives of many of these immunosuppressed children. Extra vigilance to the emergence of postoperative medical and surgical complications is mandatory.
The collaboration of surgeons, nephrologists, nurses and other paramedical staff will ensure smooth post operative course with excellent long term patient and graft outcome.