POSTOPERATIVE OUTCOME OF PEDIATRIC PATIENTS UNDERGOING RENAL TRANSPLANTATION

Abstract

BJECTIVE: To evaluate the postoperative outcome in the Intensive Care Unit (ICU) in the first month after kidney transplant. PATIENTS AND METHODS: Thirty-two patients (33 transplants), 21 male, age: 9.5 ± 3.1 yrs. Retrospective study from July/2008 to March/2012 through the variables: cold ischemia time, PRISM, mechanical ventilation (MV), vasoactive drugs (VAD), immunosuppression, infection, surgical complications, dialysis, renal function (CrCl), diuresis, hospitalization length and mortality. Statistics: Fischer and Pearson. RESULTS: Causes of CKF: uropathy-19, glomerulopathy-3, tubulopathy-2, other-7. Cold ischemia: 20hs median. PRISM score: 1.3% (0.2–6.2%), FiO2 max: 30% (21–60%), MV: 1d (0–10d), VAD 18/33 1D(0–6d). 10/33 transplants used thymoglobulin, 23/33 basiliximab. Infections: catheter-related-4, urinary-2,peritonitis-2, sepsis-1. Surgical complications: bleeding-4, thrombosis-3, urinary fistula-1. Of 5/32 dialyzed. CrCl and diuresis first postoperative day: 20 mL/min/1.73 m2 and 3.6 mL/kg/h and at 30 days: 90 mL/min/1.73 m2 and 3.7 mL/kg/h. There was an inverse correlation between cold ischemia time and CrCl in the 1st postoperative day (p = 0.01 and r = 0.45), not seen at 30d. Hospitalization length ICU = 4d (2–23d), total 15d (5 – 45d). There was no difference in infection, MV duration, use of VAD, CrCl, ICU and total hospitalization length between thymoglobulin X basiliximab use (p > 0.05). However duration of VAD utilization was higher for Thymoglobulin (p = 0.05). One patient died from sepsis (3%). CONCLUSION: The outcome after renal transplantation was satisfactory, with short ICU stay, but high use of vasoactive drugs. Bleeding was the most common surgical complication. The patient and graft survival after 1 month of transplantation was 97% and 91%, respectively.