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Assessing the role of upside-down (inverted) renal allografts in pediatric kidney transplantation: a propensity-score matched analysis

  • Urology - Original Paper
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Abstract

Objective

To evaluate the implications of inverted (upside-down) kidney configuration in pediatric renal transplantation employing a comparative analysis with at least 1-year follow-up.

Methods

Patients who underwent kidney transplantation at our institution between January 2011 and June 2021 were reviewed. Patients who had an inverted renal transplant were propensity-score matched (PSM) in 1:2 ratio with those who had traditional orientation transplant. The outcomes assessed included delayed graft function (DGF), urine leak, lymphocele, rejection, allograft calculus, ureteric stricture, and nadir creatinine.

Results

A total of 24 patients with inverted orientation were identified. Following PSM, 41 patients were matched, with exclusions due to incompatible propensity scores. Baseline characteristics were appropriately matched, and no significant differences were noted between the two groups. There were no differences in: delayed graft function (0/24 vs. 3/41, p = 0.290), urine leak (3/24 vs. 2/41, p = 0.350), lymphocele (2/24 vs. 4/41, p = 1.000), rejection (3/24 vs. 5/41, p = 1.000), graft calculus (2/24 vs. 0/41, p = 0.133), and ureteric stricture (0/24 vs. 2/41, p = 0.527). The two cases of renal calculus seen in the inverted transplant group occurred on post-operative day 13 and 1584, both were managed without complications. There was no difference in nadir creatinine (median 34umol/L IQR23-57 vs. 35 umol/L IQR 20–50, p = 0.624) or time to nadir creatinine (8 days IQR 6–12 vs. 8 days IQR 7–28, p = 0.315).

Conclusion

Inverting a renal allograft does not appear to significantly contribute to increased risk of post-operative adverse outcomes. When aiming to achieve the best anatomical placement to secure a comfortable vascular anastomosis, inverting the allograft should be considered.

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Data availability

The data and materials supporting the results or analyses presented in this paper may be available upon reasonable request.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Jin K. Kim, Priyank Yadav & Armando J. Lorenzo

  2. Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University AveToronto, Toronto, ON, M5G 1X8, Canada

    Jin K. Kim, Michael E. Chua, Mandy Rickard & Armando J. Lorenzo

  3. Institute of Urology, St. Luke’s Medical Center, Quezon City, Philippines

    Michael E. Chua

Authors
  1. Jin K. Kim
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  2. Priyank Yadav
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  3. Michael E. Chua
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  5. Armando J. Lorenzo
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Correspondence to Jin K. Kim.

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Kim, J.K., Yadav, P., Chua, M.E. et al. Assessing the role of upside-down (inverted) renal allografts in pediatric kidney transplantation: a propensity-score matched analysis. Int Urol Nephrol 55, 861–866 (2023). https://doi.org/10.1007/s11255-023-03485-5

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  • DOI: https://doi.org/10.1007/s11255-023-03485-5

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