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19–22 APRIL, 2017, BARCELONA, SPAIN
09:53–09:56
S6-4 (PP)
INTRAOPERATIVE BLOOD TRANSFUSION IN PAEDIATRIC
PATIENTS UNDERGOING RENAL TRANSPLANT – EFFECT
OF RENAL GRAFT SIZE
Martin SIDLER
1
, Rakan I. ODEH
2
, Teresa SKELTON
3
, Armando LORENZO
2
,
Walid FARHAT
2
and Martin A. KOYLE
2
1) The Hospital for Sick Children, Division of Pediatric Urology, Toronto, CANADA - 2) The Hospital for Sick Children,
Division of Pediatric Urology, Toronto, CANADA - 3) The Hospital for Sick Children, Department of Anesthesia and Pain
Medicine, Toronto, CANADA
PURPOSE
In paediatric renal transplantation (RT), graft size often exceeds desirable measures. We aimed to
quantify the effect of transplantation of an oversize kidney on recipient’s hemoglobin concentration
(Hb).
MATERIAL AND METHODS
Single institution retrospective analysis of patients undergoing RT over a 10-year period was
performed. Variables analyzed included: Age, pre- and post-operative Hb, graft size, estimated
intra-operative blood loss (EBL), intraoperative blood-transfusion. We compared patients receiving
a regular size kidney to recipients of an oversize kidney (over 95
th
percentile for age). In order to
assess the influence of graft size on transfusion requirements, we calculated expected procedure-
and transfusion-induced changes in Hb and compared these changes to observed difference in
pre- versus post-operative Hb.
RESULTS
188 patients were included. For regular size group and oversize group, mean preoperative Hb was
11.1g/dL and 10.6g/dL (p=0.35), postoperative Hb was 10.4g/dL (Range 9.8g/dL–17.3g/dL) and
10.8g/dL (Range 8.1g/dL–15.2g/dL; p=0.15), EBL/kg was 5.7mL/kg and 10.9mL/kg (p less than
0.001), respectively, while mean absolute EBL was about 200mL in both groups. Postoperative
versus preoperative Hb was 0.7g/dL lower in the regular size group while Hb was 0.2g/dL higher
in the oversize group (p<0.001). Observed Hb-increase in the oversize group was lower by 2.2g/
dL than the expected/calculated Hb-increase - while observed increase was only 1.1g/dL lower
than expected in the regular size group (p=0.003), indicating the greater blood volume taken up
by an oversize kidney. For each 1cm that the graft kidney was larger than kidney size according
to recipeint’s age (50
th
percentile), the observed increase was 3.5g/dL lower than the expected
increase based on patient’s weight and transfused blood volume.
CONCLUSIONS
Transplantation of an oversize kidney in paediatric RT is associated with a higher need of blood
transfusion. Quantification of this effect is important to anticipate actual transfusion requirements.