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Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

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Abstract

Background

This study describes the long-term results of renal autotransplantation for renovascular hypertension performed in children who are now 21 years of age or older.

Methods

Sixteen children (4 boys, 12 girls) with a mean age of 11.2 years at the time of the procedure underwent ex-vivo surgery at the university hospital of Saint-Etienne between 1992 and 2008. Acetylsalicylic acid was used for antiplatelet therapy in the postoperative period, without routine anticoagulation. The mean follow-up period was 15 years. The clinical course of these patients was retrospectively reviewed in adulthood and the results analyzed.

Results

The children were treated with a mean of 2.37 drugs per patient, and the mean preoperative blood pressure of the entire patient population was 151/89 mmHg. Mean preoperative creatinine clearance was 80 ml/min/1.73 m2. There was no postoperative death. One patient experienced a thrombosis immediately after the surgery, leading to a redo surgery. In this patient diuresis was restarted, but without efficient concentration and filtration, ultimately leading the patient to have a renal transplant after 1 year. At the end of the follow-up period, eight of the 16 patients (50%) were cured and the others were improved. At the last follow-up the mean blood pressure was 127/70 mmHg, and the mean number of drugs per patient was 0.68. The mean creatinine clearance at last follow-up was 104.3 ml/min/1.73 m2. Three patients had secondary procedures, with two undergoing percutaneous angioplasty (at postoperative months 9 and 12, respectively) and one having an hepatorenal bypass at postoperative year 4. Primary patency was 12/16 (75%); primary assisted patency was 15/16 (94%); secondary patency was 16/16 (100%).

Conclusion

This study shows that renal autotransplantation has good and stable long-term results and is an effective conservative strategy for treating renovascular hypertension in children, thus avoiding nephrectomy.

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References

  1. Kimura H, Sato O, Deguchi J-O, Miyata T (2010) Surgical treatment and long-term outcome of Renovascular hypertension in children and adolescents. Eur J Vasc Endovasc Surg 39:731–737

    Article  CAS  PubMed  Google Scholar 

  2. Eliason JL, Coleman DM, Criado E, Kershaw DB, Blatt NB, Williams DM, Dasika NL, Cho KJ, Stanley JC (2016) Remedial operations for failed endovascular therapy of 32 renal artery stenoses in 24 children. Pediatr Nephrol 31:809–817

    Article  PubMed  Google Scholar 

  3. Lacombe M (2011) Surgical treatment of renovascular hypertension in children. Eur J Vasc Endovasc Surg 41:770–777

    Article  CAS  PubMed  Google Scholar 

  4. Humbert J, Roussey-Kesler G, Guerin P, LeFrançois T, Connault J, Chenouard A, Warin-Fresse K, Salomon R, Bruel A, Allain-Launay E (2014) Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort. Eur J Pediatr 174:23–32

    Article  PubMed  Google Scholar 

  5. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114[Suppl 2]:555–576

  6. Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, Roebuck DJ (2008) Renovascular hypertension in children. Lancet 371:1453–1463

    Article  CAS  PubMed  Google Scholar 

  7. Zhu G, He F, Gu Y, Yu H, Chen B, Hu Z, Liang W, Wang Z (2014) Angioplasty for pediatric renovascular hypertension: a 13-year experience. Diagn Interv Radiol 20:285–292

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujihara M, Fukata M, Higashimori A, Nakamura H, Odashiro K, Yokoi Y (2014) Short- and mid-term results of balloon angioplasty for renal artery fibromuscular dysplasia. Cardiovasc Interv Ther 29:293–299

    Article  PubMed  Google Scholar 

  9. Srinivasan A, Krishnamurthy G, Fontalvo-Herazo L, Nijs E, Keller MS, Meyers K, Kaplan B, Cahill AM (2010) Angioplasty for renal artery stenosis in pediatric patients: an 11-year retrospective experience. J Vasc Interv Radiol 21:1672–1680

    Article  PubMed  Google Scholar 

  10. Duprey A, Favre J-P, Barral X (2009) Pseudoaneurysms postangioplasty of the renal artery: case reports and review of the literature. Ann Vasc Surg 23:258.e1–258.e7

  11. Persu A, Giavarini A, Touzé E, Januszewicz A, Sapoval M, Azizi M, Barral X, Jeunemaitre X, Morganti A, Plouin PF, de Leeuw P, ESH Working Group Hypertension and the Kidney (2014) European consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens 32:1367–1378

    Article  CAS  PubMed  Google Scholar 

  12. Persu A, Touzé E, Mousseaux E, Barral X, Joffre F, Plouin P-F (2012) Diagnosis and management of fibromuscular dysplasia: an expert consensus. Eur J Clin Investig 42:338–347

    Article  Google Scholar 

  13. Barral X, Gournier JP, Frering V, Favre JP, Berthoux F (1992) Dysplastic lesions of renal artery branches: late results of ex vivo repair. Ann Vasc Surg 6:225–231

    Article  CAS  PubMed  Google Scholar 

  14. Peruzzi L, Amore A, Coppo R (2014) Challenges in pediatric renal transplantation. World J Transplant 4:222–228

    Article  PubMed  PubMed Central  Google Scholar 

  15. Garcia CD, Bittencourt VB, Rohde RW, Dickel S, Pires I, Tumba K, Vitola SP, de Souza V, Wagner M, Garcia VD (2015) Pre-emptive pediatric kidney transplantation or not? Transplant Proc 47:954–957

    Article  CAS  PubMed  Google Scholar 

  16. Piercy KT, Hundley JC, Stafford JM, Craven TE, Nagaraj SK, Dean RH, Hansen KJ (2005) Renovascular disease in children and adolescents. J Vasc Surg 41:973–982

    Article  PubMed  Google Scholar 

  17. Stanley JC, Zelenock GB, Messina LM, Wakefield TW (1995) Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg 21:212–227

    Article  CAS  PubMed  Google Scholar 

  18. Lacombe M, Ricco J-B (2006) Surgical revascularization of renal artery after complicated or failed percutaneous transluminal renal angioplasty. J Vasc Surg 44:537–544

    Article  PubMed  Google Scholar 

  19. Stanley JC, Criado E, Upchurch GR Jr, Brophy PD, Cho KJ, Rectenwald JE (2006) Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children. J Vasc Surg 44:1219–1228

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Surgery Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France

    Bertrand Chavent, Ambroise Duprey, Jean-Noel Albertini, Jean-Pierre Favre & Xavier Barral

  2. Pediatric Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France

    Marie-Pierre Lavocat & Christine Fichtner

  3. Anesthesiology Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France

    Anne-Marie Beraud

  4. Nephrology Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France

    Nicolas Maillard

Authors
  1. Bertrand Chavent
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  2. Ambroise Duprey
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  3. Marie-Pierre Lavocat
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  4. Christine Fichtner
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  5. Anne-Marie Beraud
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  6. Jean-Noel Albertini
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  7. Jean-Pierre Favre
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  8. Nicolas Maillard
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  9. Xavier Barral
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Corresponding author

Correspondence to Bertrand Chavent.

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Conflict of interest

None of the authors have any conflict of interest related to the content of this study to disclose.

Ethic statement

This study received IRB approval under reference IRBN052017/CHUSTE.

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Chavent, B., Duprey, A., Lavocat, MP. et al. Renovascular hypertension: results in adulthood of renal autotransplantation performed in children. Pediatr Nephrol 32, 1935–1940 (2017). https://doi.org/10.1007/s00467-017-3664-x

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  • DOI: https://doi.org/10.1007/s00467-017-3664-x

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