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Dr. Elsa Mariana Zúñiga Lara - Best of the Best in Pediatric Surgery 2025
With Dr. Todd Ponsky
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Acute Cholecystitis
Todd Ponsky · 32 min · Published Jul 2026
Video
Update Course Rewind 2025: Updates in NEC Management
11 min · Published Jul 2026
Video
Pediatric Pre-Operative Bowel Prep
Todd Ponsky · 1 min · Published Jul 2026
Video
Journal of Pediatric Surgery Article Review: September 2021
Todd Ponsky · 11 min · Published Jul 2026
Video
22. HerniaTalk LIVE Q&A: Pediatric Hernias
Todd Ponsky · 59 min · Published Jul 2026
Video
ATLS 2021 Pediatric Surgery Update
Todd Ponsky · 16 min · Published Jul 2026
Video
Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
71 min · Published Sep 2026
Video
Clinical & Research Update: Neuroblastoma with Drs. Katherine Somers, Cara Morin, Juan Gurria, and Meera Kotagal
67 min · Published Sep 2026
Video
Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater
66 min · Published Sep 2026
Video
2026 Laparoscopic Pediatric Hernia Repair
123 min · Published Jun 2026
Video
Beyond the Spectrum: Diagnosis, Myths & Management - Caitlin Couch & Leslie Lopez - APP Conference 2026
50 min · Published May 2026
Video
Dysautonomia: Navigating the Journey - Martha Willis - APP Conference 2026
55 min · Published May 2026
What the experts said
Kidney transplantation is the best treatment for end stage kidney disease.
Vascular complications are more frequent in pediatric kidney transplantations with an incidence up to 15%.
Vascular complications are a frequent cause of graft loss in pediatric kidney transplantation.
During the study period (January 2012 to December 2023), 307 kidney transplants were performed with an average age of 10 years and weight of 42 kg.
The principal causes of renal failure in the cohort were unknown etiology, uropathies, and glomerulopathy.
There were six vascular complications in the series, representing 1.9% incidence: two arterial thrombosis, two venous thrombosis, one arterial bleed, and one angular artery complication.
Three of the six vascular complications required nephrectomy, and the other three had the graft saved by early reintervention.
Vascular complications were present more in patients with low weight and with a history of thrombosis and thrombophilia.
Prolonged times of warm ischemia, total ischemia, deceased donor, more proximal anastomotic site, and transperitoneal surgical approach were most related to developing vascular complications.
Logistic regression analysis identified that history of thrombosis or thrombophilia, transperitoneal approach, and total ischemia per minute were most related to developing vascular complications.
A calculator was created that estimates the probability for developing vascular complications with a risk of 93.04% if all three risk factors are present.
Arterial and venous thrombosis were the cause of graft loss in 0.9% of the cases.
The incidence of vascular complication in this series is 1.9%, which compares favorably with other kidney transplant series.
Arterial thrombosis and venous thrombosis each occurred in only 0.6% of cases.
The institution conducts exhaustive evaluation prior to transplant, with all children undergoing a series of analyses checking variables that could predict vascular complications.
Vascular complications were more common with deceased donors compared to living donors, though not statistically significant.
Perioperative hemodynamic monitoring and goals are important for addressing vascular thrombosis in pediatric transplantation, given varied causes of end stage kidney disease and size considerations.