Aims: Our study aims to describe the clinical features, laboratory findings and treatment during the intraoperative and early postoperative phases, and to identify early complications following pediatric kidney transplantation at Children’s Hospital 2.
Methods: A retrospective case series of 32 pediatric kidney transplant recipients (30 from living donors and 2 from deceased donor) was conducted from January 2004 to December 2024.
Results: The mean age at transplantation was 12.7 ± 2.2 years, with an average waiting time of 15.6 months. The most common cause of end-stage renal disease was congenital renal hypoplasia (28.1%). Immediate postoperative urine output was observed in 84.4% of patients. 87.5% of patients required inotropes: Dopamine (53.1%), Noradrenaline (12.5%), or a combination of Dopamine + Adrenaline or Noradrenaline (21.9%). Most patients (93.8%) received Simulect as induction immunosuppression and all patients received maintenance immunosuppression with Prednisone + MMF, combined with Tacrolimus (81.3%) or Cyclosporin A (18.7%). Mean urine output in the first 24 hours was 11.5 ml/kg/h, decreasing to 6.6 ml/kg/h by day 3. Fluid intake averaged 7677.6 ml/m²/day on day 1 and 3386.4 ml/m²/day on day 3. Median serum creatinine decreased from 737 µmol/L preoperatively to 108 µmol/L on day 3. The average systolic and diastolic blood pressure in the first 24 hours were 141 ± 10.3 mmHg and 86 ± 8.9 mmHg, respectively. Hypertension occurred in 81% of patients and was managed with Nicardipine (average duration: 2.9 ± 1.9 days). The most common surgical complications during the early postoperative period were postoperative bleeding and lymphocele, each accounting for 6.2%. The most frequent medical complications were urinary tract infection (21.9%) and delayed graft function (15.6%).
Conclusions: Careful perioperative fluid and hemodynamic management is vital for optimizing graft function and minimizing early complications. Standardized protocols and close monitoring are essential to improve outcomes in pediatric kidney transplantation.