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Original Articles

The immediate postoperative complications and outcomes of kidney transplantation in children

Authors:

M A M Faizal ,

Sirimavo Bandaranaike Specialized Hospital for Children, Peradeniya, LK
About M A M
Consultant Paediatric Intensivist, Paediatric Intensive Care Unit, Sirimavo Bandaranaike Specialized Hospital for Children, Peradeniya
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M M E D Dissanayake,

Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, LK
About M M E D
Temporary Lecturer, Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya
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D Withanawasam,

Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, LK
About D
Temporary Lecturer, Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya
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D M A U K Dissanayake,

Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, LK
About D M A U K
Temporary Lecturer, Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya
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C K Abeysekera,

Department of Paediatrics, Faculty of Medicine, University of Peradeniya, LK
About C K
Professor in Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Peradeniya
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A Abeygunawardana,

Department of Paediatrics, Faculty of Medicine, University of Peradeniya, LK
About A
Professor & Head, Department of Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Peradeniya
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M. D. Lamawansa,

Department of Surgery, Faculty of Medicine, University of Peradeniya, LK
About M. D.
Professor & Head, Department of Surgery, Department of Surgery, Faculty of Medicine, University of Peradeniya
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C. D. A. Goonasekera

Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, LK
About C. D. A.
Professor  of Anaesthesiology, Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya
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Abstract

Objective: To evaluate the preoperative status of children admitted for renal transplantation, and their supportive care, complications and outcomes during the immediate postoperative period in the intensive care unit (ICU).

Design: Prospective observational study

Setting: ICU, Teaching Hospital, Peradeniya (THP)

Patients: Children who underwent renal transplantation at THP from July 2004 to October 2008

Measurements: Data regarding preoperative status and postoperative ICU complications was recorded in an Excel work sheet.

Results: Of 28 recipients of kidney transplantation at this centre during the specified period, 19 were male with a mean age of 9.6 (range 2-16) years. The commonest cause of end stage renal disease (ESRD) was obstructive uropathy (28.6%). All received live donor transplantation. The mean (±SD) pre-transplant haemoglobin (Hb) and blood urea were 9.28± 2.42g/dl and 2l.97±10.17mmol/L respectively. Of the patients78.5% did not meet the minimum satisfactory Hb levels. Pre-operatively, 68.4% of the patients were hypertensive in spite of 18 (64.3%) of them being on regular antihypertensive treatment. One patient (3.6%) had haemodialysis (HD), 8 (28.6%) had peritoneal dialysis (PD) and 2 (7.1%) had had both prior to transplant. Seventeen (60.7%) were pre-emptive transplants. The mean (± SD) creatinine and creatinine clearance were 460.91±261.55 micromol/L  and 22.89±25.98 ml/min/1.73m2 respectively. Mean (±SD) duration of mechanical ventilation during the immediate postoperative period was 4.88±2.80 days while the mean (±SD) ICU stay was 6.44 ± 3.35 days.  Postoperative ICU complications occurred in 75% of transplant recipients. Hypertension (46%), metabolic complications such as acidosis, hyperglycaemia, hypocalcaemia, hyponatraemia (32%), heart failure (29%), convulsions (25%) and sepsis (25%) were the more common. Post-transplant creatinine and creatinine clearance were 60.69±31.19 micromol/L and 114±48 ml/min/1.73m2 respectively. No deaths or lost grafts were reported during the study period.

Conclusion: Kidney transplantation in the current context warrants a significant duration of ICU therapy postoperatively in children.

(Key words: Paediatric renal transplantation; complications; intensive care)

DOI: http://dx.doi.org/10.4038/sljch.v41i2.4393


How to Cite: Faizal, M.A.M. et al., (2012). The immediate postoperative complications and outcomes of kidney transplantation in children. Sri Lanka Journal of Child Health. 41(2), pp.65–70. DOI: http://doi.org/10.4038/sljch.v41i2.4393
Published on 11 Jun 2012.
Peer Reviewed

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