Upside-down kidney placement: Alternative in pediatric renal
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“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 this study is to analyze whether the placement of the upside-down kidney could affect graft outcome or produce more complications.

A retrospective study was conducted of pediatric kidney transplants performed 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.

From 181 transplants, 167 grafts were placed in a normal position (mean age: 10 yrs. and mean weight: 30 kg) and 14 were placed upside-down (10 yrs., 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. In the latter group, no grafts have been lost due to vascular or urological causes and no patients have required dialysis.

When necessary, an upside-down placement for the renal graft is a safe alternative in the pediatric population.

source: https://www.sciencedirect.com/science/article/abs/pii/S0022346820306680
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