Which of the following is FALSE regarding the surgical course of renal transplant in a 12 kg 20-month-old recipient?
a) Systemic heparinization will likely be utilized.
b) The graft is usually placed retroperitoneally rather than in the pelvis.
c) A living donor adult graft may be used, but risks the sequestration of significant blood volume on reperfusion.
d) A history of preoperative dialysis is associated with poorer outcomes.
Answer b. Because of the size and volume of what is likely to be a disproportionally large graft (it is very uncommon to receive a cadaveric graft of matching size for such a young or small patient), the donor graft in patients under 15-20 kg is customarily placed in the peritoneal cavity rather than the pelvis. Retroperitoneal placement has been associated with graft compression and malperfusion. Because of the complicated nature of small vascular anastomoses and their propensity for thrombosis, the donor renal artery is anastomosed directly to the recipient’s aorta, and the graft renal vein to the recipient’s IVC. Such large vessel anastomoses require clamping of these great vessels and usually involve low-dose systemic heparinization.