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Living donor kidney transplantation in pediatric recipients
1Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA. shapiror@upmc.edu
Insights
Living donor kidney transplantation in children is increasingly common and successful. Advances in immunosuppression and surgical techniques have led to excellent patient and graft survival rates, with falling rejection.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Immunosuppression Therapy
Background:
- Living donor kidney transplantation is a growing procedure in pediatric patients, representing over half of North American cases by 2004.
- Historical data shows a significant increase in its frequency over recent decades.
Purpose of the Study:
- To review the trends and outcomes of living donor kidney transplantation in pediatric recipients.
- To identify factors contributing to improved graft and patient survival rates.
Main Methods:
- Analysis of transplant data from North America between 1987 and 2004.
- Review of changes in immunosuppressive regimens and surgical approaches.
Main Results:
- Patient survival exceeds 96% at five years; graft survival is over 95% at one year.
- Rejection rates have decreased to below 25% overall.
- Improvements linked to tacrolimus-based immunosuppression and newer adjunctive agents like mycophenolate mofetil or sirolimus.
- Steroid withdrawal/avoidance shows promising early results.
- Donor nephrectomy type may impact early outcomes, especially in very young recipients.
Conclusions:
- Living donor kidney transplantation offers excellent long-term outcomes for pediatric patients.
- Advances in immunosuppression and surgical strategies continue to enhance success rates.
- Further research into donor nephrectomy techniques and immunosuppression protocols is warranted.
Abstract:
Living donor kidney transplantation has increased in frequency in pediatric patients, accounting for 43% of cases performed between 1987 and 1991, and 52% of cases performed between 1987 and 2004 in North America. Patient survival has remained excellent over the years, and is currently over 96% at five years. Graft survival has improved over the years, and is currently over 95% at one year. Rejection rates have fallen over the years, and are currently <25% overall, with selected centers having very low rejection rates. The reasons for these improved outcomes are likely related to improvements in maintenance immunosuppression, which include a transition from cyclosporine to tacrolimus-based regimens, and from azathioprine to mycophenolate mofetil or sirolimus as adjunctive agents. Steroid withdrawal and steroid avoidance are beginning to be utilized by several centers, with excellent early outcomes. Finally, while there may be center effect/learning curve issues involved, the type of donor nephrectomy has recently been shown to influence early outcomes, particularly in very young recipients.
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