ESPU Meeting on Friday 19, April 2024, 16:15 - 16:40
16:15 - 16:18
S20-1 (OP)
Carlos DELGADO-MIGUEL 1, Virginia AMESTY 2, Susana RIVAS 2, Roberto LOBATO 1, Ane ANDRÉS 1, Francisco HERNÁNDEZ-OLIVEROS 1, María José MARTÍNEZ-URRUTIA 2 and Pedro LÓPEZ-PEREIRA 2
1) La Paz Children's Hospital, Pediatric Surgery Department, Madrid, SPAIN - 2) La Paz Children's Hospital, Pediatric Urology Department, Madrid, SPAIN
PURPOSE
Preformed donor-specific antibodies (pDSA) in kidney transplant recipients cause postoperative antibody-mediated rejection and lower long-term kidney allograft survival compared with that observed in transplanted patients without pDSAs. Our aim was to compare the long-term outcomes according to the presence of pDSA in children with simultaneous liver-kidney transplantation (SLKT).
MATERIAL AND METHODS
A retrospective case-control single-center study was conducted in children who underwent SLKT between 1997-2022. We analyzed demographic, clinical and laboratory data collected pre-transplantation and postoperatively. Patients were divided into two groups based on the presence or absence of pDSA.
RESULTS
Twenty-one patients were included, with a median age of 10.2 years (Q1-Q3: 8.5-14.5 years) and median long-term follow-up of 13.5 years (Q1-Q3: 1.5-24.3 years). Eighteen patients (85.7%) had neither class I nor II pDSA, while 4 patients had pDSA prior to SLKT, with a corresponding negative cross-match. In all patients both grafts were obtained from the same cadaveric donor, who had the same blood type as the recipient. After SLKT, pDSA became undetectable in these 4 patients, with a median time of 10 weeks after transplantation (Q1-Q3: 1-24 weeks). No differences in postoperative complications were observed between both groups (p=0.21). At long-term follow-up, the graft survival and overall survival rates were 100% and 100%, respectively, in patients with pDSAs, and 92.8% and 100% in patients without pDSAs.
CONCLUSIONS
SLKT can be considered as a successful alternative to transplant highly sensitised patients in the absence of an antibody compatible donor. Preimplantation of the liver may protect the subsequent kidney transplant by adsorption of donor HLA-specific antibodies, with no observed differences when compared to patients without pDSA.
16:18 - 16:21
S20-2 (OP)
Sharon MOHAN KUNNATH 1, Arash TAGHIZADEH 2, Pankaj MISHRA 2, Anu PAUL 2, Martin DRAGE 3, Louise PARAMORE 4, Ewan BROWNLEE 4 and Massimo GARRIBOLI 2
1) Evelina London Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, Department of Pediatric Nephrology and Urology, Children's Bladder Service, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, Department of Pediatric Nephrology and Urology, Children's Bladder Service, London, UNITED KINGDOM - 3) Evelina London Children's Hospital, Department of Pediatric Nephrology and Urology, London, UNITED KINGDOM - 4) Southampton Children's Hospital, Paediatric Urology, Southampton, UNITED KINGDOM
PURPOSE
Ureterostomy of the transplant kidney is performed when the bladder is deemed unsafe at the time of transplant as a temporising measure until bladder reconstruction. We aimed to review our experience with this technique with particular focus on complications and long-term outcome.
MATERIAL AND METHODS
The charts of patients receiving a transplant ureterostomy at two tertiary Paediatric Urology centres were studied. Outcome measures were stomal stenosis and need for revision/reinterventions.
RESULTS
11 patients who received ureterostomy of the transplant kidney were reviewed. Median age at transplant was 35 months(26-47 months).
7 have already undergone bladder reconstruction with reimplantation of the transplant ureter after a median of 51 months(46-55 months). 6 had Ileocystoplasty, 1 had Mainz pouch. Of these, 6 had no stomal issues prior to reimplantation. 1 of them required a dilatation 12 months post-transplant but worked well until ileocystoplasty.
4 patients still have the transplant ureterostomy that has lasted for a median of 35 months (9.25-25 months) without needing revision. Among these, 1 patient had a temporary stent for 3 months for a rise in Creatinine, but obstruction was ruled out on a retrograde study.
CONCLUSIONS
With the limitation of the small cohort, our results suggest that transplant ureterostomy is a feasible and safe option to consider as temporary approach to renal transplant in patients with unsafe bladder awaiting bladder reconstruction.
16:21 - 16:24
S20-3 (OP)
Franziska Juliane RICHTER 1, Fabian DOKTOR 2, Mandy RICKARD 1, Priyank YADAV 3, Jin K. KIM 1, Michael E. CHUA 1 and Armando J. LORENZO 1
1) The Hospital for Sick Children (SickKids), Division of Urology, Toronto, CANADA - 2) The Hospital for Sick Children (SickKids), Peter Gilgan Centre for Research and Learning, Developmental and Stem Cell Biology Program, Toronto, CANADA - 3) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Urology, Lucknow, INDIA
PURPOSE
Childhood obesity is increasing and may be considered a relative contraindication to perform pediatric kidney transplantation due to suboptimal outcomes. Herein we aimed to determine if pediatric patients with elevated body-mass index (BMI) (>85thpercentile) are at higher risk for short-term complications.
MATERIAL AND METHODS
After review of our transplant database (2010-2020), patients >2 – 18 years were assigned to groups based on BMI percentiles at the time of surgery: A (normal; 5th-85th percentile; n=120) and B (obesity and overweight; >85thpercentile; n=60). Patients underwent a 1 to 2 ratio nearest-neighbor matching with propensity score based multivariable logistic regression model adjusting for age, sex and underlying diagnosis.
RESULTS
Of 180 included patients, group B underwent transplantation significantly earlier in life (p=0.0041) than group A (66.5 months;IQR25,221 vs. 130.0 months;IQR24,209), with lower creatinine levels at 3 and 6 months as well as 1 year postoperatively. There was no difference in OR times, warm ischemia time, time to nadir creatinine, severity of and time to complications (p>0.05). However, more patients in group B required intraoperative blood transfusions (p=0.0063) with comparable blood loss and stayed longer at the hospital (LOS,p=0.0149).
Table1.Characteristics of both groups.
|
Variable |
Group A (n=120) |
Group B (n=60) |
p-value |
|
BMI percentile |
49.2(IQR5.3,84.0) |
93.3(IQR85.1,99.9) |
<0.0001* |
|
Male/female |
68/52 |
37/23 |
0.6307 |
|
Rejections (%) |
8.4(10/120) |
8.33(5/60) |
>0.9999 |
|
Creatinine 1 year postoperatively(µmol/L) |
60.5(IQR22,783) |
41.0(IQR21, 344) |
0.0024* |
|
Nadir creatinine (µmol/L) |
36.0(IQR10,145) |
26.0(IQR6,120) |
0.0046* |
|
Time to nadir creatinine (days) |
7.0(IQR1,679) |
9.0(IQR1,690) |
0.1143 |
|
LOS(days) |
15.0 (IQR7, 49) |
18.0 (IQR9, 133) |
0.0149* |
|
Intraoperative blood transfusion(%) |
33.4(40/120) |
55.0(33/60) |
0.0063* |
CONCLUSIONS
The results of this study confirm that obesity in pediatric kidney transplant patients does not lead to higher likelihood of postoperative complications or worse graft function on early postoperative monitoring. Findings related to increased use of blood products and longer hospital stay deserve further evaluation.
16:24 - 16:27
S20-4 (OP)
Marios MARCOU 1, Matthias GALIANO 2, Anja TZSCHOPPE 2, Katja SAUERSTEIN 2, Sven WACH 3, Helge TAUBERT 3, Bernd WULLICH 3, Hendrik APEL 3 and Karin HIRSCH-KOCH 3
1) University Hospital Erlangen, Paediatric Urology, Erlangen, GERMANY - 2) University Hospital Erlangen, Clinic of Pediatrics and Adolescent Medicine, Erlangen, GERMANY - 3) University Hospital Erlangen, Clinic of Urology and Pediatric Urology, Erlangen, GERMANY
PURPOSE
Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation.
MATERIAL AND METHODS
We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival.
RESULTS
Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at five, ten, fifteen and twenty years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1m2, pretransplantation duration of the recipient on dialysis ≥18 months and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival.
CONCLUSIONS
Importantly, the pretransplantation recipient time on dialysis was associated with the highest risk of graft failure.