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Treatment of children in the U.S. with end-stage renal disease (ESRD)
1Department of Pediatrics, Tulane University Health Sciences Center, Tulane Hospital for Children, New Orleans, Louisiana, USA.
Insights
This study followed 10,434 children with end-stage renal disease, detailing transplant outcomes and dialysis survival rates. Pediatric kidney transplantation shows promising long-term patient and graft survival, especially with living related donors.
Area of Science:
- Pediatric Nephrology
- Renal Transplantation
- Chronic Kidney Disease
Background:
- The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) has tracked over 10,000 children with end-stage renal disease (ESRD) or chronic renal insufficiency.
- Pediatric kidney transplantation and maintenance dialysis are critical interventions for managing chronic renal insufficiency in children.
Purpose of the Study:
- To analyze the outcomes of renal transplantation and long-term dialysis in a large cohort of pediatric patients.
- To identify factors influencing patient survival, graft survival, and complications such as post-transplant lymphoproliferative disorder (PTLD).
Main Methods:
- Retrospective analysis of data from 10,434 children followed by NAPRTCS.
- Detailed review of 5,958 renal transplants, including pre-transplant dialysis modalities, donor types, and immunosuppressive therapies.
- Analysis of maintenance dialysis data for 3,748 patients, focusing on dialysis modality, peritonitis rates, and treatment with erythropoietin (EPO) and growth hormone (GH).
Main Results:
- Renal transplantation outcomes: 5-year patient survival was 93.5%, with 5-year graft survival at 80% for living related donors (LRD) and 65% for deceased donors (CD). Time to first rejection episode was significantly longer for LRD (755 days) vs. CD (98 days).
- Dialysis outcomes: 3-year patient survival on dialysis was 86.5%, varying by age. Peritoneal dialysis (PD) was the primary modality (67%), with a peritonitis rate of 0.86 episodes/year.
- Growth and complications: 75 cases of PTLD were reported. Growth hormone therapy improved standard deviation scores (SDS) for height by -0.30 after one year.
Conclusions:
- Pediatric renal transplantation, particularly with LRD, offers favorable long-term patient and graft survival.
- Maintenance dialysis remains a viable option for pediatric ESRD, with PD being the predominant modality.
- Effective management strategies are crucial for addressing complications like PTLD and growth failure in pediatric renal disease patients.
Abstract:
USA 10,434 children with End State Renal Disease or chronic renal insufficiency have been followed by NAPRTCS. 5958 renal transplants have been performed. Haemoidalysis preceeded Tx in 28%, PD in 47% and 24% were preemptive transplants. The most common diagnoses were obstructive uropathy, renal dysplasia, FSGN, reflux nephropathy and CGN. 20.4 were < 5 and 24.9% < 12 years or age a transplant. 57.7% had living related donors. The most common therapy is with prednisone, cyclosporine and mycophenalate mofetile. Time to 1st rejection episode is 755 days in LRD and 98 days in CD. 5 year patient survival is 93.5% and 5 year graft survival in LRD is 80% and in CD is 65%. 75 cases of PTLD have been reported. 3748 patients have had maintenance dialysis. Peritoneal dialysis was the main modality in 67% and hemodialysis in 39%. 0.86 episodes/year of peritonitis has occurred in PD patients. 94% of patients received EPO therapy and 15% received growth hormone therapy. 3 year patient survival on dialysis is 86.5% (69.5% in those < 1 to 92.4% in those > 12 yrs of age). 3863 patients with chronic renal insufficiency have been followed. Mean height by standard deviation score is -1.41 with one third -1.88. Growth hormone for one year increased SDS by -0.30.
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