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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Renal transplantation in children younger than 6 years old
C D Garcia1, V B Bittencourt, F Pires
1Complexo Hospitalar Santa Casa, FFFCMPA, Porto Alegre, RS, Brazil. cdgarcia1@uol.com.br
Insights
Pediatric renal transplantation in children under six years old demonstrates favorable long-term outcomes. This study highlights successful patient and graft survival rates, supporting early kidney transplant interventions.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Immunology
Background:
- End-stage renal disease (ESRD) in young children presents significant challenges.
- Renal transplantation is a critical treatment option for pediatric ESRD.
- Limited data exists on long-term outcomes for very young pediatric kidney transplant recipients.
Purpose of the Study:
- To report the experience and outcomes of renal transplantation in children aged 1 to 5 years.
- To analyze patient and graft survival rates in this specific pediatric cohort.
- To evaluate the safety and efficacy of different immunosuppressive strategies.
Main Methods:
- Retrospective analysis of 40 renal transplants performed in 38 children (ages 1-5) between 1989 and 2005.
- Data collection included demographics, etiology of ESRD, pre-transplant management, donor type, immunosuppression protocols, and outcomes.
- Patient and graft survival rates were calculated using Kaplan-Meier analysis.
Main Results:
- The primary causes of ESRD were uropathic/vesicoureteral reflux (45%) and glomerulopathy (25%).
- Living-related donors were used in 75% of cases.
- Five-year patient survival was 89.6% and graft survival was 72.2%, with 32.5% graft loss attributed to various causes.
Conclusions:
- Renal transplantation can achieve good long-term results in children younger than 6 years old.
- Early kidney transplantation is a viable and effective treatment for pediatric end-stage renal disease.
- Careful patient selection and management optimize outcomes in this challenging population.
Abstract:
Herein we report our experience in renal transplantation in 38 children (40 transplants), ages 1 to 5 years, between 1989 and 2005. Demographics as well as patient and graft survivals are reported. Mean age at transplantation was 3.3 +/- 1.3 years, and mean weight was 14 kg (range, 5.7-25 kg); 92.5% were Caucasian, 7.5% African-Brazilian. The main etiology for end-stage renal disease (ESRD) was uropathic/vesicoureteral reflux (45%) followed by glomerulopathy (25%), congenital/hereditary diseases (10%), and hemolytic uremic syndrome (12.5%). Prior to transplantation, 5% were on hemodialysis, 85% on peritoneal dialysis, and 10% preemptive. All children were followed for at least 6 months posttransplantation, except 2 who died in the first month. In 75% of cases, kidneys were obtained from living-related donors, and in 25% from deceased donors. Thirty-nine kidneys were extraperitoneally placed. Primary immunosuppressant therapy consisted of cyclosporine (61%), tacrolimus (39%), mycophenolate (49%), and azathioprine (51%). A steroid-free protocol was used in 17% of patients. In the last 21 cases, basiliximab or daclizumab was added. There were 13 (32.5%) graft losses (4 artery/vein thromboses, 3 chronic rejections, 3 deaths, 3 other causes). The 5-year patient and graft survival rates were 89.6% and 72.2%. We have concluded that renal transplantation can be performed with good long-term results in children younger than 6 years old.
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