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Intra-abdominal Complications After Pediatric Kidney Transplantation

Incidence and Risk Factors

Taher, Amir1; Zhu, Benjamin1; Ma, Sophia1; Shun, Albert, MBBS1,2; Durkan, Anne Maria, MD1,2

doi: 10.1097/TP.0000000000002420
Original Clinical Science—General

Background. The incidence and types of intra-abdominal complications after pediatric transplantation are not well established, and specific risk groups have not been clearly identified.

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

Results. There were 146 transplants meeting the inclusion criteria. The mean follow-up time was 4.6 ± 3.7 years (range, 0.3–18 y). The mean weight at transplantation was 31.5 ± 16.5 kg (range, 9–78), with 24 (16%) recipients being <15 kg and 23% younger than 5 years. Thirty-four (23%) patients 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 after renal vein thrombosis. Weight <15 kg 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 <15 kg (P = 0.003) and previous abdominal surgery (P = 0.008) were retained in the multivariate analysis.

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

1 Department of Nephrology, The Children’s Hospital at Westmead, Sydney, Australia.

2 Department of Transplantation, University of Sydney, Sydney, Australia.

Received 8 May 2018. Revision received 6 August 2018.

Accepted 8 August 2018.

S.M. received a University of Sydney Summer Student Research Scholarship.

The authors declare no conflicts of interest.

A.T. participated in the data collection, data analysis, and article writing. B.Z. participated in the data collection and analysis. S.M. participated in the data collection. A.S. participated in the article writing and review. A.M.D. participated in the study design, article writing, and review.

Correspondence: Anne Durkan, Department of Nephrology, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. (

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