Dr. Elsa Mariana Zúñiga Lara - Best of the Best in Pediatric Surgery 2025

All right. Um, and then the last one from this heat, also from the, uh, Mexican Pediatric Surgical Society, uh, is Dr. Elsa Mariana, uh, Zuniga Lara, and she is presenting incidence and risk factors for vascular complications in pediatric kidney transplantation, and she's coming from the Children's Hospital of Mexico Federico Gomez. Hello, my name is Mariana. I'm a pediatric surgery resident of the Children Hospital of Mexico Federico Gomez. And today I'm going to present you my work entitled incidence and risk factors for vascular complications in pediatric kidney transplantation. This work was made along with the transplant department. As you all know, 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%, which make them a frequent cause of graph blast. The objective of this work was to determine the incidence and risk factors for vascular complications in one of the largest pediatric series in the country. For this, we made an observational, longitudinal, and retrospective study of a pediatric kidney transplant cohort conducted at a single center from January 2012 to December 2023. We analyze recipient demographic variables, donor type, graph characteristics, surgical technique, and ischemia times. A univariate analysis was performed. For qualitative variables, we use chi square test and for quantitative variables, we use a student T test. The logistic regression formula was used in conditional mode to estimate the probability of each subject having vascular complication. During this period, 307 kidney transplants were performed with an average age of 10 years and weight of 42 kg. The principal causes of renal failure were unknown, uroppathies and glomerulopathy. There were six vascular complications, which means 1.9%. Two arterial thrombosis, two Venus thrombosis, one arterial bleed and one angular artery. Three of the six vascular complications required nephrectomy, and the other three, the graph was saved by early reintervention. Here we have the first three cases. In the first one it was Venus thrombosis. It was in a patient of four years. It was from a deceased donor and it requiredctomy andctomy. The second case was an arterial thrombosis. It was from the same donor as the previous one and also requiredctomy andctomy. The third case was an arterial bleeding. It was secondary to ature dessance which required operation and the graph was saved. In the next cases, we had an arterial thrombosis in a patient of five years. It requiredctomy and the graph was saved. In the fifth case it was an angular artery which required operation on the same date and the graph was saved. The last one and the most complicated one was a Venus thrombosis in a patient of five years with history of thrombosis and thrombolia positive and vascular station. It requiredctomy,ctomy and it sadly passed away. We analyzed the demographic variables and we encountered that the vascular complications were present more in patients with low weight and with a history of thrombosis and thrombolia. When we analyze graph and surgical technique variables, we encountered that prolonged times of warm ischemia, total ischemia, a disease donor, a most proximal anastomic side and a transperitoneal surgical approach were the most related to developing vascular complications. Doing a logistic regression analysis, we encountered that the history of thrombosis or thmophilia, transperitoneal approach and total ischemia per minute were the most related to developing vascular complications, which allow us to create a calculator that estimates the probability for developing them with a risk of 93.04% if we have the three barrier. As conclusions, the incidence of vascular complication in our series is extremely low, 1.9%, which compares probably with other kidney transplant series of our countries. The two most fear complications, arterial thrombosis and Venus thrombosis occur only in 0.6 of each of cases each. They were the cause of graflos in 0.9% of the cases, and the risk factors associated with vascular complication were history of thrombosis and thrombolia, transperitoneal approach and total ischemia time. Thank you. All right. Thank you so much for the presentation, Mariana. Mira, I think we have a question. Yes, thank you so much. I'm actually asking a question from one of our partners, Dr. Alex Bandok, who's one of our pediatric transplant surgeons, but is actually dealing with some transplant stuff right now. So in his stead, um he he commented on the fact that one of the challenges to pediatric transplantation is that there's such varied causes of end stage kidney disease in different age groups as well as all the size considerations to doing transplants in little kids. And so the perioperative hemodynamic monitoring and goals are really important for addressing vascular thrombosis. So he was curious if there were if your institution follows a set of guidelines or or or things that you use particularly to guide perioperative management for CVP, your blood pressure goals, etc. resuscitation. Yes, well, in our Institute, we try to conduct a very exhaustive evaluation previous to the transplant. all the kids have to pass for a series of analysis, checking all the variables that could prolong or could predict some of the vascular complications. And that was the fact that we created the calculator, so we can estimate the probability for having those complications and we encounter that the principal three were the history of thrombosis that we analyzed previously, the prolonged ischemia times that has to do with the transplant and the fact that they well have a a history of previous diseases. Did you see any difference um between deceased donors and living donors in terms of your outcomes? It wasn't um statistically significant, but we encountered that it is more common with deceased donors. Fantastic. Thanks for a great study and for presenting today. Thank you. Thank you, Mariana. All right, so. Thank you. We are going to go uh to the poll now and uh pick uh uh the favorite of this heat. Um and so we have a lot about uh image guidance here. Um from Dr. Lautz, um and also uh Dr. Ortega, um some transplant and some neuroblastoma, a little bit of a mix. So let's see what people like. Looks like uh Looks like people are very interested in image guided surgery. Um. Yeah. As those were the top two uh picks. So I I do think this is obviously a very exciting emerging technology that uh people are wanting to hear about. Um I think it's going to change change the face of of surgery. So I think we can call it here. Uh, so Dr. Timothy Lautz, uh on the ubiquitous folate receptor expression uh in pediatric and adolescent tumors using fluorescence uh wins this round. So thank you all so much. Uh, congratulations, Tim.