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Progress in renal transplantation for children.
1Division of Nephrology, Children's Hospital and Regional Medical Center, University of Washington, Seattle 98105, USA.
Advances in Renal Replacement Therapy
|April 27, 2000
Summary
Pediatric renal transplantation aims to treat end-stage renal disease, considering various patient factors. While outcomes improve, they still trail adult transplantation, highlighting areas for advancement in pediatric kidney transplants.
Area of Science:
- Nephrology
- Pediatric Surgery
- Immunology
Background:
- End-stage renal disease (ESRD) in children necessitates renal transplantation as the primary treatment.
- Successful pediatric kidney transplantation requires careful consideration of numerous patient-specific factors.
Purpose of the Study:
- To review key considerations and current practices in pediatric renal transplantation.
- To highlight ongoing challenges and areas for improvement in pediatric kidney transplant outcomes.
Main Methods:
- Comprehensive review of factors influencing pediatric renal transplant timing and success.
- Analysis of current immunosuppressive strategies and emerging therapies.
- Examination of common complications and post-transplant care.
Main Results:
- Optimal transplant timing depends on age, disease, psychosocial status, donor type, and urologic health.
- Pre-transplant immunizations and screening for infectious agents (EBV, CMV, HIV, Hepatitis) are crucial.
- Standard immunosuppression includes prednisone, calcineurin inhibitors (cyclosporine/tacrolimus), and antiproliferative agents (mycophenolate mofetil/azathioprine), with novel agents like sirolimus under investigation.
Conclusions:
- Infection, rejection, and malignancy remain significant challenges in pediatric kidney transplantation.
- Focus on optimizing growth and development post-transplant is essential.
- Despite improvements, pediatric renal transplant outcomes still lag behind adult results, necessitating continued research and clinical advancements.