Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

Pediatr Nephrol. 2017 Oct;32(10):1935-1940. doi: 10.1007/s00467-017-3664-x. Epub 2017 Apr 20.

Abstract

Background: This study describes the long-term results of renal autotransplantation for renovascular hypertension performed in children who are now 21 years of age or older.

Methods: Sixteen children (4 boys, 12 girls) with a mean age of 11.2 years at the time of the procedure underwent ex-vivo surgery at the university hospital of Saint-Etienne between 1992 and 2008. Acetylsalicylic acid was used for antiplatelet therapy in the postoperative period, without routine anticoagulation. The mean follow-up period was 15 years. The clinical course of these patients was retrospectively reviewed in adulthood and the results analyzed.

Results: The children were treated with a mean of 2.37 drugs per patient, and the mean preoperative blood pressure of the entire patient population was 151/89 mmHg. Mean preoperative creatinine clearance was 80 ml/min/1.73 m2. There was no postoperative death. One patient experienced a thrombosis immediately after the surgery, leading to a redo surgery. In this patient diuresis was restarted, but without efficient concentration and filtration, ultimately leading the patient to have a renal transplant after 1 year. At the end of the follow-up period, eight of the 16 patients (50%) were cured and the others were improved. At the last follow-up the mean blood pressure was 127/70 mmHg, and the mean number of drugs per patient was 0.68. The mean creatinine clearance at last follow-up was 104.3 ml/min/1.73 m2. Three patients had secondary procedures, with two undergoing percutaneous angioplasty (at postoperative months 9 and 12, respectively) and one having an hepatorenal bypass at postoperative year 4. Primary patency was 12/16 (75%); primary assisted patency was 15/16 (94%); secondary patency was 16/16 (100%).

Conclusion: This study shows that renal autotransplantation has good and stable long-term results and is an effective conservative strategy for treating renovascular hypertension in children, thus avoiding nephrectomy.

Keywords: Children; Renovascular hypertension; adulthood; autotransplantation; strategy..

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Drug Therapy, Combination / methods
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Hypertension, Renovascular / diagnosis
  • Hypertension, Renovascular / etiology
  • Hypertension, Renovascular / physiopathology
  • Hypertension, Renovascular / surgery*
  • Kidney / blood supply
  • Kidney / physiopathology
  • Male
  • Platelet Aggregation Inhibitors / therapeutic use
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Postoperative Period
  • Renal Artery / transplantation*
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Thrombosis / epidemiology*
  • Thrombosis / etiology
  • Thrombosis / prevention & control
  • Transplantation, Autologous / adverse effects
  • Transplantation, Autologous / methods
  • Treatment Outcome
  • Vascular Grafting / adverse effects*
  • Vascular Grafting / methods
  • Vascular Patency
  • Young Adult

Substances

  • Platelet Aggregation Inhibitors