Anastomoses vasculares no transplante renal pediátrico e uma nova estratégia para anastomoses em crianças de baixo peso

• Ano de defesa: 2014
• Autor(a) principal: Gomes, Adriano Luis [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300002t56c
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: kidney transplantation; pediatrics; surgical anastomosis; postoperative complications; transplante renal; pediatria; anastomose cirúrgica; complicações pós-operatórias
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=1936494; https://repositorio.unifesp.br/handle/11600/47137

Introduction: The technical aspects of renal transplantation (RT) performed in children should be specific, particularly with regard to vascular anastomoses (VA) in those that are lower-weight. Objectives: To assess the main VA options in paediatric renal transplantations and propose a new strategy for renal artery trajectory when using the aorta (Ao) and the inferior vena cava (iVC) on the right side. Methods: Data were obtained through a retrospective review of medical records. The sample was represented by 81 patients consecutively undergoing transplantation at Hospital Samaritano in the city of São Paulo, who were classified into two groups: Group 1 (G1) consisted of children under 16 kg, and Group 2 (G2) with children weighing 16 kg or more. Results: The smaller children (G1) received the graft predominantly on Ao and iVC (63%), while the options used for VA varied in children weighing 16 kg or more (G2), predominanting the anastomoses on the common iliac vessels (46%). In the first group, when the Ao was the selected vessel for anastomosis on the right side, the trajectory adopted for the transplanted kidney artery was posterior to the iVC. No vascular complications related to the surgical technique were observed. Conclusions: The Ao and the iVC were the main options for the VA in G1, while the common iliac artery and vein were commonly used in G2. The trajectory for the renal artery posterior to the iVC is feasible and can eliminate one of the possibilities of compression of this vein, and also allows the reconstitution of the usual anatomical pathway of the renal artery on the right side.