Simultaneous Native Right Nephrectomy and Extraperitoneal Pediatric Kidney Transplantation Using the Same Incision for Both Surgeries.

Background: Kidney transplantation is the best option for pediatric patients with end-stage kidney disease but remains challenging due to donor-recipient size mismatch. The intraperitoneal approach is associated with high morbidity, while the extraperitoneal approach is safer and more feasible. The latter approach often requires performing a native kidney nephrectomy to create sufficient space for graft placement. Clinical outcomes following simultaneous native right nephrectomy and extraperitoneal kidney transplantation through the same incision in pediatric recipients were assessed.

Methods: We retrospectively reviewed all pediatric patients (age ≤18yr) at our center during 2017-2023 who received a simultaneous right native nephrectomy and open extraperitoneal kidney transplant through the same incision.

Results: Among 125 pediatric patients who received an extraperitoneal kidney transplant, 7 patients underwent a right native nephrectomy through the same incision at the time of kidney transplant. Median age-at-transplant was 4yr (range: 3-10yr); all patients were male. Median recipient weight was 16.5kg (range: 11.9-29.7kg). Median donor age was 26yr (range: 13-46yr). Three were deceased donors after brain death; 4 were living related donors. Median warm and cold ischemia times were 30min (range: 24-42min) and 171min (range: 26-1166min), respectively. Median estimated blood loss was 15ml (range: 5-50ml). There were no cases of delayed graft function. Median creatinine at 1, 3, 6, and 12 months' post-transplant was 0.5 (range: 0.3-0.8), 0.4 (range: 0.4-0.8), 0.5 (range: 0.4-0.7), and 0.6 (range: 0.5-0.9) mg/dL, respectively, with no reported post-operative vascular or urological complications.

Conclusion: The extraperitoneal surgical approach of performing simultaneous right nephrectomy and kidney transplantation using the same incision was safe and feasible without postoperative complications, avoiding 2-step procedures or 2 incisions.