Overcoming anatomical barriers in pediatric kidney transplantation.

BACKGROUND: Pediatric kidney transplantation in patients with inherited disorders and associated congenital anomalies constitutes a true challenge, especially in low weight recipients (< 15-20 kg). Potential barriers for a successful transplant involve size-mismatch between donor organ and recipient as well as identification of suitable vascular anastomotic sites in case of vascular anomalies. CASE - DIAGNOSIS/TREATMENT: We present a case of a 5-year-old girl with azygos continuation of the inferior vena cava (IVC), a condition generally precluding transplantation of an adult-sized kidney as adequate venous outflow from the transplant cannot be achieved. By interposing a prosthetic vascular graft, the donor renal vein was anastomosed to the suprahepatic IVC, thereby enabling transplantation of a live donor kidney to the pediatric recipient with the technical success being reflected in immediate graft function.

CONCLUSION: Anatomical barriers such as azygos continuation of the IVC do not preclude kidney transplantation from a size-mismatched adult live donor a priori but demand a patient-tailored innovative surgical approach and a committed multidisciplinary perioperative management to potentially overcome this kind of vascular anomaly.