SURGICAL COMPLICATIONS AFTER KIDNEY TRANSPLANTATION IN PEDIATRICS
DOI:
https://doi.org/10.46793/PP260125013DKeywords:
kidney transplantation, surgical complications, urological complications, vascular complications, Lymphatic complicationsAbstract
Introduction: Kidney transplantation represents the gold standard for the management of chronic kidney disease. The three-year graft survival rate is approximately 90%, while five-year post-transplant patient survival reaches 95%. In pediatric recipients, the principal criterion for surgical eligibility is body weight. Transplantation extends patient life expectancy by 25–30 years, and the average functional lifespan of the allograft ranges from 12 to 15 years.
Etiology: The most common causes of terminal renal failure in children are hereditary and congenital disorders (38%), followed by primary glomerulopathies (25%) and secondary glomerulopathies (12%). Patient age correlates closely with underlying pathology and guides subsequent diagnostic evaluation.
Surgical Complications: Postoperative complications occur in 10–20% of recipients and represent a significant source of morbidity. They may be classified temporally into early and late events, or etiologically into urological, vascular, hemorrhagic, lymphatic complications, and those related to the surgical wound. Urological Complications: Early urological complications, within the first postoperative month, include ureteral stenosis and urinary leakage, whereas late complications, appearing months after surgery, primarily manifest as delayed ureteral obstruction. Literature reports a slightly higher incidence of late events (9% vs. 4%). Vascular complications constitute a leading cause of early graft loss and include arterial stenosis, venous and arterial thrombosis, hematoma, and pseudoaneurysm formation. Lymphatic Complications: Lymphoceles are accumulations of lymphatic fluid in the perivascular and periureteral space that occur in 0.5–22% of cases. They may be asymptomatic or present with diverse clinical features. Accurate differentiation from hematoma, seroma, urinoma, and other fluid collections is essential.
Conclusion: Despite significant advancements in surgical techniques, immunosuppressive therapy, and perioperative care, postoperative surgical complications remain a major clinical challenge and a key determinant of graft and patient outcomes.
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