Single-center retrospective cohort of 218 children undergoing first kidney transplant (2008–2015) to define severe perioperative hemorrhage using cluster analysis plus clinical criteria, then identify risk factors and outcomes including 5-year graft survival.
Severe hemorrhage occurred in 16/218 cases (7.3%). Key risk factors included younger/smaller recipients, older donors, living donors, and higher graft-to-recipient size ratio. Five-year graft survival was markedly lower in the hemorrhage group (62.5% vs. 91.5%, p < 0.001); hospital stay was longer (10 vs. 7 days, p = 0.003). Patient mortality did not differ between groups.
- Retrospective, single-center design (2008–2015) limits causal inference and generalizability. - Small number of events (n=16) prevented multivariable logistic regression, so independent risk factors could not be confirmed. - Data are relatively old; institutional changes in 2016 precluded extending the dataset.
In small pediatric kidney transplant recipients receiving large grafts—especially from living or older donors—monitor closely for bleeding in the first 24 hours post-op, as this group faces significantly lower 5-year graft survival when severe hemorrhage occurs. Early use of plasma, cryoprecipitate, or platelets (even at low volumes) may signal clinically relevant hemorrhage requiring prompt escalation.
