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Pediatr Transplant. 2017 Nov;21(7). doi: 10.1111/petr.13006. Epub 2017 Jul 3.

Incidence and risk factors of early surgical complications in young renal transplant recipients: A persistent challenge.

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Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Division of Nephrology, McMaster Children Hospital, McMaster University, Hamilton, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON, Canada.
University Health Network, Toronto, ON, Canada.
Dalla Lana School of Public Health, Toronto, ON, Canada.


There is a paucity of data on the rate of urological and vascular complications in very young children after kidney transplant. We conducted a study on the incidence and risk factors for early post-transplant surgical complications in young recipients (<5 years) over three decades. The primary outcome was any urological or vascular complication within 30 days of transplant, and the secondary outcome was incidence rate of graft failure reported as per 1000 person-years. Risk factors associated with surgical complications were analyzed by logistic regression. There were 22 (26.5%) complications in 21 children with vascular thrombosis being the most common complication. There was no significant difference in the number of complications in period 1 (1985-1994) and period 2 (1995-2014) (P=.1). The incidence rate of graft failure was higher in period 1 (IR 70.8, 95% CI 41.1, 121.9) compared to period 2 (IR 20.7, 95% CI 9.3, 46.0). Cumulative incidence of graft survival at 1, 3, and 5 years' post-transplant was 96.5%, 92.6%, and 90%, respectively, in those without compared to 71%, 65.1%, and 58.6%, respectively, in children with complications. In conclusion, early surgical, especially vascular, complications are quite common in young renal transplant recipients and lead to significantly reduced graft survival.


outcome; renal transplantation; surgical complications; time trends; young children

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