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Kidney transplantation in young children: should there be a minimum age?
1Department of Surgery, University of Minnesota, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA. abhinav.humar-2@tc.umm.edu
Insights
Kidney transplants in infants under one year old show comparable survival rates to older children. This suggests that age alone should not dictate transplant timing, challenging traditional waiting policies.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Immunology
Background:
- Optimal age for pediatric kidney transplantation is debated, with many centers delaying it based on historical data suggesting poorer outcomes in younger children.
- This cautious approach is often based on older studies showing inferior graft survival in very young recipients.
Purpose of the Study:
- To evaluate kidney transplant outcomes in children under one year old compared to older pediatric recipients.
- To determine if a minimum age or weight threshold is necessary for successful pediatric kidney transplantation.
Main Methods:
- Retrospective analysis of 321 kidney transplants performed between 1984 and 1999 in children aged 13 years or younger.
- Patients were categorized into three age groups: <1 year (n=30), 1-4 years (n=122), and 5-13 years (n=169).
- Comparison of patient survival, graft survival, rejection rates, and post-transplant growth between the age groups.
Main Results:
- No significant differences in patient or graft survival rates were observed between the three age groups.
- Infants (<1 year) demonstrated lower incidences of acute and chronic rejection but a trend towards higher delayed graft function and vascular thrombosis.
- Infant recipients showed significant improvements in weight and height post-transplant, with all infant recipients alive and well at the study's conclusion.
Conclusions:
- Pediatric kidney transplantation in children under one year old can achieve outcomes comparable to those in older children.
- There is no need for a minimum age or weight requirement for kidney transplantation in pediatric end-stage renal disease.
- Transplant timing should be individualized, considering factors beyond just age or size.
Abstract:
The optimal age for transplantation in children with end-stage renal disease remains controversial. Many centers have adopted a policy of waiting until such children reach a certain minimum age or weight, maintaining them on chronic dialysis until then. Their policy is based on historical data showing inferior graft survival in very young children. We feel that with proper donor selection and recipient care, comparable results can be achieved in very young age groups. We herein present our results with kidney transplantation in children <1 year old. Between 1 January 1984 and 31 December 1999, we performed 321 kidney transplants in children < or =13 years at the University of Minnesota. We analyzed our results in three age groups: <1 year (n=30), 1 through 4 years (n=122), and 5 through 13 years (n=169). We found no significant differences in patient or graft survival rates between the three groups. Almost all our infant (<1 year) recipients underwent primary transplants from living donors (LDs). However, even when we compared results only of primary LD transplants between the three groups, we found no significant differences. To date, all our infant recipients are alive and well, 24 (80%) with a functioning original graft. Causes of the 6 graft losses were chronic rejection (n=3), vascular thrombosis (n=2), and recurrent disease (n=1). Infants had significantly lower incidences of acute and chronic rejection compared with older recipients, but a tendency to higher incidences of delayed graft function and vascular thrombosis. Infants had significant increases in weight post transplant: the mean standard deviation score rose from -2.8 pre transplant to -0.2 by age 5 years and to +1.8 by age 10 years. The improvement in height was less marked: the mean standard deviation rose from -3.2 pre transplant to -1.6 by age 5 years and to -1.4 by age 10 years. Kidney transplant results in very young children can be comparable to those in older children. There need be no minimum age for performing a kidney transplant. The timing of the transplant should not be based on age or size alone.