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Overview of pediatric renal transplantation
1Department of Pediatrics, University of Minnesota, Minneapolis.
Insights
Pediatric renal transplantation has become the preferred treatment for end-stage renal disease (ESRD) in children. Successful kidney transplants significantly improve growth and development in young recipients, supporting early intervention.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Pediatric Gastroenterology
Background:
- Renal transplantation in children has evolved significantly over 35 years.
- It is now the primary treatment for pediatric end-stage renal disease (ESRD).
- The number of children with functioning transplants has quadrupled in recent years.
Purpose of the Study:
- To analyze the outcomes of renal transplantation in infants and children.
- To identify factors influencing patient and graft survival.
- To assess the impact of transplantation on growth and development.
Main Methods:
- Retrospective analysis of 495 renal transplants performed between 1963 and the present.
- Examination of variables including donor type, transplant era, and recipient age.
- Evaluation of growth parameters (head circumference, stature) and developmental scores post-transplant.
Main Results:
- Primary renal transplants, living-related donor grafts, and transplants since 1979 show improved outcomes.
- Recipient age did not impact patient or graft survival.
- Transplanted infants demonstrated accelerated head growth and improved developmental scores, with statural growth also improving.
Conclusions:
- Early and aggressive management, including prompt renal transplantation, is recommended for pediatric ESRD.
- Dialysis should be utilized primarily as a bridge to elective transplant surgery.
- Successful renal transplantation significantly benefits growth and development in pediatric patients.
Abstract:
Over 35 years, renal transplantation in infants and children has evolved dramatically. Once a desperate effort, transplantation is now the therapy of choice for virtually all children with end-stage renal disease (ESRD). The number of children less than 10 years old living with ESRD has more than doubled in the last 7 yr, but during that same interval the children with functioning transplants has quadrupled. Since 1963, 386 children and 21 infants have received 495 renal transplants at the University of Minnesota. When examined, several variables strongly influence the outcomes. Primary renal transplants, grafts from living-related donors, and transplants performed since 1979 have all been associated with markedly improved outcomes. But age of the recipient has no impact on either patient or graft survival. Beneficially, transplanted infants experience significantly accelerated head growth, returning them to the normal range. Their development test scores also significantly improve, again bringing them into the normal range. Finally, statural growth regularly improves following successful transplantation. These results support a strategy of early, aggressive support; prompt renal transplantation; and the use of dialysis primarily as a critical "bridge" to elective transplant surgery.