The role of transesophageal echocardiography in transplantation of an adult-sized kidney to a small child

Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challenge to both surgical and anesthetic management. For survival of the graft, a large-size kidney graft transferred to a pediatric patient needs extraphysiological cardiac output to compensate for adequate renal blood flow. We report here a boy weighing 8.4 kg who received transplantation of a kidney donated by his 56.4-kg mother. Since monitoring of the central venous pressure was not accurate enough and Swan-Ganz catheterization was not feasible in this patient for monitoring the fluid status and cardiac function, we used transesophageal echocardiography to guide intravascular volume expansion and to titrate inotropic support during the surgery. It was demonstrated to be a useful tool for optimization of renal perfusion in this scenario. The transplanted graft served its function well.