Abdominal compartment syndrome in pediatric kidney transplantation.

Background: Transplantation of large kidney in small children can lead to many complications. One of these, often underrated, is abdominal compartment syndrome (ACS). An early diagnosis of ACS is recommended to prevent multi-organ failure. Patient and Methods: From June 1985 to June 2007 we have performed 314 kidney transplants (KT) in pediatric patients (male/female: 167/147). Deceased donors were used in 289 procedures, while 25 KT were carried out from living related donors. In this cohort, the weight of 83 kidney recipients was less than 20 Kg. Of these patients, 16 received a large kidney. Results: ACS occurred in 7 kidney recipients (hemodialysis/peritoneal dialysis: 5/2). All patients weighted less than 15 Kg. The kidney was procured from adult donors. The ACS signs included firm tense abdomen, hypotension, reduction in ventilation, decrease in lung compliance, increase in airways pressure (increase peak inspiratory pressure), impaired gas exchange with possible hypercarbia and acidosis. In one case a patient underwent abdominal decompression by re-exploration and closure with a PTFE mesh in the immediate post-operative period. From 2005 we measured during transplantation the possible intra-abdominal hypertension via urinary bladder pressure. Conclusions: In pediatric kidney recipients, especially for the condition “large kidney in small children”, the continuous measurement of urinary bladder pressure may be a simple, non invasive and inexpensive approach to provide an early detection of ACS.