Abstract
Purpose
“Upside-down” kidney placement has been reported as an acceptable alternative in cases
of technical difficulty in kidney transplantation but there are few reports in the
pediatric population.
The aim of our study is to analyze whether the placement of the upside-down kidney
could affect graft outcome or produce more complications.
Materials and methods
A retrospective study was conducted of pediatric kidney transplants performed in our
center between 2005 and 2017 with at least 6 months' follow-up.
Epidemiological and anthropometric data, type of donor (deceased/living), graft position
(normal/upside-down), reason for the upside-down placement, early, medium and long-term
complications and renal function were analyzed and compared with patients transplanted
in the same period with a normal graft placement.
Results
From 181 transplants, 167 grafts were placed in a normal position (mean age: 10 y
and mean weight: 30 kg) and 14 were placed upside-down (10 y, 37 kg) mainly because
of vessel shortness after laparoscopic nephrectomy. Male predominance was observed
in both groups.
57% of grafts from the control group and 64% of those from study group came from a
living donor.
Four vascular and two ureteral re-anastomoses were recorded in the control group and
two vascular and one ureteral re-anastomosis in the study group (p > 0.05). In the
latter group, no grafts have been lost due to vascular or urological causes and no
patients have required dialysis.
Conclusions
When necessary, an upside-down placement for the renal graft is a safe alternative
in the pediatric population.
Level of evidence
Level III.
Abbreviations:
Renal transplantation (RT), End-stage renal disease (ESRD)Key words
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Article info
Publication history
Published online: September 29, 2020
Accepted:
September 16,
2020
Received in revised form:
September 8,
2020
Received:
June 1,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
