Current perspectives on kidney transplantation in low-weight pediatric patients. Review
DOI:
https://doi.org/10.30978/GS-2026-2-70Keywords:
kidney transplantation, pediatric, low body weight, donor-recipient size mismatch, vascular complications, graft thrombosis, compartment syndrome, surgical approach, hemodynamicsAbstract
Kidney transplantation is the treatment of choice for children with end-stage renal disease, providing superior survival and quality of life compared to dialysis. However, transplantation in children with low body weight (≤ 20 kg) remains technically demanding and is associated with a higher risk of complications. These challenges are primarily related to donor–recipient size mismatch, limited anatomical space, and hemodynamic constraints. A narrative review of the literature was performed, focusing on surgical techniques, anatomical and hemodynamic factors, and early and late complications of kidney transplantation in low-weight pediatric recipients. Particular attention was given to the impact of size mismatch, the choice of surgical approach, and strategies for prevention and early detection of vascular complications.
Donor-recipient size mismatch was identified as a central pathophysiological factor influencing outcomes. It contributes to a complex cascade involving impaired venous outflow, graft edema, increased intrarenal pressure, and secondary reduction of arterial perfusion. Both intraperitoneal and extraperitoneal approaches are effective, with no consistent differences observed in long-term graft survival. Outcomes are primarily determined by the adequacy of graft positioning and perfusion. Vascular complications, particularly arterial and venous thrombosis, remain the leading cause of early graft loss in this population. Renal allograft compartment syndrome is a specific manifestation of mechanical and hemodynamic imbalance. Early diagnosis using Doppler ultrasonography and prompt surgical intervention are critical for graft preservation.
Kidney transplantation in children with low body weight requires an integrated surgical and perioperative strategy aimed at compensating for anatomical and hemodynamic mismatch. The success of transplantation depends on the coordinated optimization of graft positioning, vascular geometry, space creation, and postoperative monitoring, rather than on a single technical factor. A proactive, mechanism-based approach is essential to reduce complications and improve outcomes in this high-risk population.
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