Kidney Week

Abstract: SA-PO037

Timing of Native Nephrectomy and Kidney Transplant Outcomes in Children

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Kizilbash, Sarah J., University of Minnesota, Minneapolis, Minnesota, United States

Sarah J. Kizilbash,

• Balaji, Priyamvadha, University of Minnesota, Minneapolis, Minnesota, United States

Priyamvadha Balaji,

• Tejpaul, Resha, Univ of MN Dept of Urology, Minneapolis, Minnesota, United States

Resha Tejpaul,

• Lewis, Jane Marie, University of Minnesota, Minneapolis, Minnesota, United States

Jane Marie Lewis,

• Verghese, Priya, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, United States

Priya Verghese,

Background

Native nephrectomies are indicated for various reasons in pediatric kidney transplant (pKtx) candidates. Nephrectomies may be performed prior to (2-stage) or at the time of transplant (1-stage). The optimal timing of nephrectomies remains controversial and there are no data comparing the outcomes associated with two approaches.

Methods

We retrospectively examined 32 consecutive pKtx recipients who underwent native nephrectomies at the University of Minnesota between 01/01/2011 and 12/31/2016. We investigated the effect of the timing of nephrectomy on patient and graft survival using Kaplan-Meir and log-rank test. We compared categorical variables using Fisher exact and continuous variables using Wilcoxon rank sum tests.

Results

Our cohort included 21 patients with 1-stage and 11 patients with 2-stage nephrectomies. Clinical characteristics are presented in table 1. Although statistically insignificant, patients with 2-stage tended to be older. Indications for nephrectomy included vesicoureteral reflux/urinary infections (40.6%), nephrotic syndrome (31.3%) and cystic kidney diseases (15.6%). There were no differences in the indications for nephrectomy between 1-stage versus (vs.) 2-stage patients. There was no difference in the rate of peri-operative complications between two groups. For 2-stage, median length of hospital stay (LOS) after nephrectomy was 7.5 days (range: 6-10), and median time to transplant was 4.3 months (range: 3-73) for living and 15 months (range: 3 -180) for deceased donor recipients. Posttransplant LOS was significantly shorter for 2-stage patients (median days: 12 vs. 8, p 0.03). There were no differences in 1-year patient (100% vs. 100%, p 1.0) or graft survival (95% vs. 90.9%, p 0.68) between 1-stage vs. 2-stage patients.

Conclusion

There were no differences in 1-year patient and graft survival between pKtx recipients with 1-stage vs. 2-stage native nephrectomies. Posttransplant LOS was shorter for patients undergoing 2-stage nephrectomies; however, they required two hospitalizations.