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The first 25 slides, exactly as they appear. The full deck has 84 content slides.
Paediatric Surgery
Renal Transplantation
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 84 slides
Overview
- What this deck will teach you
Why children need a transplant
End-stage renal disease, its causes, and why a graft beats dialysis
- End-stage renal disease (ESRD) and its rescue
- How childhood kidney failure differs from adults'
- Causes of ESRD in children awaiting transplant, by age
- Outcomes have steadily improved
- Patient survival after pediatric kidney transplant
- Graft survival by donor source over the years
- Success brings new long-term challenges
- Two emerging groups of complex candidates
- Caring for fetal-care-center graduates
Preparing the child for transplant
Optimizing kidney function, the bladder, and the whole child before surgery
- Medical management while still in CKD
- Contraindications to renal transplantation
- Why urologists are central to CKD care
- The 'valve bladder' — a lifelong moving target
- Tools for the hostile bladder
- Medical preparation is a team sport
- Nutrition, growth, and immunization
- The whole child and family
- Planning access and correcting thrombosis risk
- Urological prep: the bladder first
- Bladder cycling and complex reconstruction
- Indications for pretransplant native nephrectomy
- The logic of removing native kidneys
- Strategic and technical nephrectomy considerations
- Bladder augmentation: choosing the patch
- Ureterocystoplasty, undiversion, peritoneum
Timing and choosing the donor kidney
When to transplant and where the kidney comes from
- Timing and pre-starting immunosuppression
- Preemptive transplantation — skipping dialysis
- Deceased vs living donors: the best kidney
- En bloc kidneys and DCD donors
The transplant operation
Retrieving the kidney, from either donor, and placing it in the child
- Deceased donor management and retrieval
- Sequence of organ removal
- Preservation solutions: keeping the kidney alive on ice
- Static cold storage vs machine perfusion
- Living donor management: ethics come first
- Protecting the donor and expanding the pool
- Living donor nephrectomy technique
- Delivering the living-donor kidney
- Recipient management: the pre-incision setup
- Incision and where the kidney goes
- Vascular anastomosis in an infant recipient
- Making the vascular connections
- Reconstructing difficult donor vessels
- Avoiding hypotension — a graft-losing danger
- Ureteral reimplantation: connecting kidney to bladder
- Extravesical ureteral reimplantation (detrusorrhaphy)
- Building an antirefluxing tunnel
After the transplant
Recovery, the anti-rejection drugs, and the complications to anticipate
- Immediate postoperative care
- Immunosuppression: no 'one size fits all'
- The typical initial regimen
- A caution on mTOR inhibitors
- Managing early hypertension
- Early electrolyte and lipid problems
- Infection prophylaxis after transplant
- The EBV–PTLD problem
- Early graft dysfunction: reading the warning signs
- When output falls after an initial good start
- Surgical complications by the numbers
- Renovascular complications
- Wound complications and hemorrhage
- Urolithiasis after transplant
- Reflux and UTIs after transplant
Long-term care and outcomes
From discharge to decades, and the challenges that remain
- Transition to outpatient care
- Maintenance immunosuppression over time
- Long-term aspects and chronic allograft injury
- Death-censored graft failure: deceased donor recipients
- Death-censored graft failure: living donor recipients
- Graft failure among deceased donor recipients
- Smarter monitoring and the sensitized patient
- Adherence, transition, and donor follow-up
- Summary — the essentials to carry away
- Why is protecting the bladder so central to pediatric kidney transplant success?
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology