# Management of Surgical Complications in Pediatric Kidney Transplantation

## TL;DR

This paper reviews surgical complications in pediatric kidney transplants, highlighting their impact on graft survival and the need for improved surgical techniques and postoperative care.

## Contribution

A comprehensive summary of post-transplant surgical complications in children, emphasizing the need for prospective studies to improve outcomes.

## Key findings

- Vascular complications, such as arterial stenosis and venous thrombosis, are the leading cause of graft nephrectomy in pediatric kidney transplantation.
- Urologic complications, particularly vesicoureteral reflux, are more common in children due to pre-existing genitourinary abnormalities.
- Meticulous surgical techniques and close postoperative surveillance are critical to reducing the risk of allograft loss in pediatric recipients.

## Abstract

Introduction: Graft and patient survival after kidney transplantation in children has increased in the past decade; however, post-transplant surgical complications occur in up to 15.4% of recipients and pose a significant threat to graft survival. Due to anatomic discrepancies in children, kidney transplantation in this population is nuanced and requires meticulous planning. This narrative review summarizes the most common postoperative surgical complications following kidney transplantation in children. Methods: PubMed and Google Scholar were queried for full-text articles that reported pediatric kidney transplantation surgical complications and their management following kidney transplantation. Results: Vascular complications can occur in approximately 1.3–13.8% of cases and are the leading cause of graft nephrectomy, with arterial stenosis and venous thrombosis being the most common. Urologic complications occur in 1.3–30% of patients and are more frequent in children due to pre-existing genitourinary abnormalities prior to transplantation. Vesicoureteral reflux is the most common urologic complication. Discussion: Surgical complications following kidney transplantation in children continue to significantly affect graft viability. Ultimately, meticulous surgical techniques and close postoperative surveillance are critical to mitigating the risk of allograft nephrectomy. Prospective studies focused on best surgical practice, techniques, prevention, and postoperative care in pediatric kidney transplant recipients are needed.