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Published on: May 7, 2019
Renal transplantation in children
M Samhan1, T Fathi, N Al-Kandari
1Hamed Al-Essa Organ Transplantation Centre, Kuwait. masamhan@gmail.com
Insights
Pediatric renal transplantation offers excellent outcomes for end-stage renal disease (ESRD). Living donor transplants and older recipients showed higher graft survival rates, demonstrating the success of this life-saving procedure.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Immunology
Background:
- End-stage renal disease (ESRD) in children necessitates renal transplantation as the primary treatment.
- Pediatric ESRD patients often present with complex medical histories and high-risk factors.
- This study evaluates the outcomes of renal transplantation in a pediatric cohort.
Purpose of the Study:
- To analyze the results of renal transplantation in children with ESRD at a single center.
- To identify factors influencing graft survival and patient outcomes.
- To assess the long-term efficacy of renal transplantation in pediatric ESRD.
Main Methods:
- Retrospective analysis of 86 pediatric renal transplant recipients (November 1993 - June 2006).
- Data collected on donor type (living vs. cadaveric), recipient age, high-risk factors, and immunosuppression protocols.
- Outcomes assessed included surgical complications, rejection episodes, infections, graft loss, and survival rates.
Main Results:
- High 1- and 10-year actuarial recipient survival rates (99% and 98%).
- 10-year graft survival rates were 98% for living donor transplants (LDTx) and 64% for cadaveric donors (CDTx).
- Older recipients (>10 years) had better graft survival (86%) than younger children (<10 years) (75%).
Conclusions:
- Renal transplantation is a highly effective treatment for pediatric ESRD.
- Living donor kidney transplantation and transplantation in older children are associated with superior graft survival.
- Pediatric renal transplant recipients with functioning grafts achieve full rehabilitation.
Objective:
Renal transplantation is the preferred method for the treatment of children in end-stage renal disease (ESRD). In this retrospective study, we analyzed the results at our center.
Patients And Methods:
Between November 1993 and June 2006, 86 children (50 boys and 36 girls) received organs from 50 living donors (LDTx) and 36 cadaveric donors (CDTx). Twenty children were <10 years. In addition to ESRD, some patients had one or more other high-risk factors, eg, abnormal lower urinary tract in 36 recipients (42%). The procedure was a preemptive transplantation in 28, and a retransplantation in 9 recipients. Induction immunosuppression used either antithymocyte globulin (43 cases) or anti-interleukin-2 receptor antibodies (20 cases).
Results:
Patients were followed for 6 to 150 months. There were 24 surgical complications (28%), 26 acute rejection episodes (33%), and 17 of systemic bacterial or viral infections. Two recipients died at 1 and 21 months. The 14 grafts were lost at 1 day to 87 months. The 1- and 10-year actuarial survival rates were 99% and 98%, respectively, for the recipients, and 88% and 84%, respectively, for the grafts. The 10-year actuarial graft survival rates were 98% in LDTx and 64% in CDTx; 86% in recipients >10 years old and 75% in recipients <10 years old. Abnormal urinary tract, pretransplantation dialysis, and transplant number showed no effect on graft survival. All pediatric recipients with functioning grafts are fully rehabilitated.
Conclusion:
Renal transplantation is the preferred method of treatment for children in ESRD. Higher graft survival rates were achieved in older children and following LDTx.
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