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Timing of native nephrectomy and kidney transplant outcomes in children
Author(s) -
Kizilbash Sarah J.,
Huynh Dao,
Kirchner Varvara,
Lewis Jane,
Verghese Priya S.
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13952
Subject(s) - medicine , nephrectomy , surgery , kidney , urology , vesicoureteral reflux , kidney transplantation , hypoalbuminemia , urinary system , transplantation , reflux , disease
Abstract Background No consensus exists on the optimal timing for native nephrectomy in pediatric kidney transplant recipients. Data comparing outcomes between recipients undergoing pretransplant nephrectomy (staged nephrectomy with subsequent transplant) and those undergoing nephrectomy simultaneously with the transplant are lacking. Method We studied 32 pediatric kidney transplant recipients who underwent native nephrectomy at a single center from 01/01/2011 to 12/31/2016. We divided recipients into two groups based on the nephrectomy timing (simultaneous nephrectomy/transplant and staged nephrectomy). We used Wilcoxon rank‐sum test, Fisher's exact test, and Kaplan‐Meier methods to compare outcomes. Results Of 32 recipients, 20 underwent simultaneous and 12 underwent staged nephrectomy. Simultaneous recipients were younger (median (years): 2.0 vs 7.0; P = .049). Staged recipients were more likely to have proteinuria/hypoalbuminemia, whereas simultaneous recipients were more likely to have hydronephrosis/vesicoureteral reflux/urinary infections as nephrectomy indications ( P = .06). Median prenephrectomy albumin for patients with nephrotic syndrome was significantly lower in staged recipients (median g/dL: 1.9 vs 3.8; P = .02). Total number of hospital days (including both procedures) was higher for staged recipients compared with simultaneous (one procedure) recipients (median (days): 17.0 vs 11.5; P = .05). We observed no difference in 5‐year graft survival between the groups (95.0% vs 91.7%, P = .73). Patient survival was 100% in both groups over a median follow‐up of 44.2 months. Surgical complications were similar between the groups. Conclusion Staged and simultaneous native nephrectomy in pediatric kidney transplant recipients are associated with comparable outcomes.