ABSTRACT
Objective: To evaluate the preoperative status of children admitted for renal transplantation, and their supportive care, complications and outcomes during the immediate postoperative period in the intensive care unit (ICU). Design: Prospective observational study Setting: ICU, Teaching Hospital, Peradeniya (THP) Patients: Children who underwent renal transplantation at THP from July 2004 to October 2008 Measurements: Data regarding preoperative status and postoperative ICU complications was recorded in an Excel work sheet. Results: Of 28 recipients of kidney transplantation at this centre during the specified period, 19 were male with a mean age of 9.6 (range 2-16) years. The commonest cause of end stage renal disease (ESRD) was obstructive uropathy (28.6%). All received live donor transplantation. The mean (±SD) pre-transplant haemoglobin (Hb) and blood urea were 9.28± 2.42g/dl and 2l.97±10.17mmol/L respectively. Of the patients78.5% did not meet the minimum satisfactory Hb levels. Pre-operatively, 68.4% of the patients were hypertensive in spite of 18 (64.3%) of them being on regular antihypertensive treatment. One patient (3.6%) had haemodialysis (HD), 8 (28.6%) had peritoneal dialysis (PD) and 2 (7.1%) had had both prior to transplant. Seventeen (60.7%) were pre-emptive transplants. The mean (± SD) creatinine and creatinine clearance were 460.91±261.55 micromol/L and 22.89±25.98 ml/min/1.73m2 respectively. Mean (±SD) duration of mechanical ventilation during the immediate postoperative period was 4.88±2.80 days while the mean (±SD) ICU stay was 6.44 ± 3.35 days. Postoperative ICU complications occurred in 75% of transplant recipients. Hypertension (46%), metabolic complications such as acidosis, hyperglycaemia, hypocalcaemia, hyponatraemia (32%), heart failure (29%), convulsions (25%) and sepsis (25%) were the more common. Post-transplant creatinine and creatinine clearance were 60.69±31.19 micromol/L and 114±48 ml/min/1.73m2 respectively. No deaths or lost grafts were reported during the study period. Conclusion: Kidney transplantation in the current context warrants a significant duration of ICU therapy postoperatively in children.