Severe bleeding During pediatric kidney transplantation, this occurred in 7.3% of cases in a single-center cohort and was associated with a significant reduction in five-year post-graft survival, highlighting important risk factors associated with surgery and donors.
Severe bleeding in pediatric kidney transplantation
In a retrospective single-center study of 218 children who underwent their first kidney transplant between 2008 and 2015, major bleeding was identified in 16 cases. Investigators used data-driven cluster analysis to identify major bleeding based on high perioperative bleeding volume and blood component requirements. Major bleeding was also defined by the need for reoperation or administration of factor VII or fibrinogen for implant-related bleeding.
Thirty-eight exposure variables were analyzed, including clinical and laboratory data, donor and recipient characteristics, surgical technique variables, and medications. Unadjusted logistic analyzes showed that major bleeding was more frequent among younger and younger recipients, children receiving kidneys from older donors, and those receiving kidney transplants from living donors. A higher graft dose was also associated with an increased risk. Among laboratory markers, postoperative platelet count was associated with severe bleeding.
Risk factors for severe bleeding
Data suggest that donor type and size mismatch play a major role in the development of severe bleeding. The combination of small beneficiaries and large donors emerged as a major risk factor. Researchers suggest that having more abdominal dissection in young children who receive large grafts may contribute to an increased risk of bleeding.
These findings are notable regarding surgical planning and donor selection, especially in young children. The frequency of severe bleeding observed in this group was higher than previously reported in the literature, highlighting the need for careful perioperative evaluation.
Impact on graft survival and clinical outcomes
Severe bleeding had important consequences on long-term outcomes. Five-year postgraft survival was significantly lower in children with major bleeding than in those without: 62.5% versus 91.5%; p
The analysis of bleeding consequences also took into account delayed kidney function, length of hospital stay during transplantation, estimated glomerular filtration rate after transplantation, and five-year survival of the patient.
Overall, these data underscore the importance of recognizing risk factors for severe bleeding in pediatric kidney transplantation and designing perioperative strategies to mitigate bleeding risks and improve graft outcomes.
reference
Maya MLA et al. Severe perioperative bleeding in pediatric kidney transplantation: frequency, risk factors, and outcomes. Pediatr Nephrol. 2026; doi: 10.1007/s00467-026-07391-7.
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