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Kidney transplantation in infants and small children
Blanche Chavers1, John S Najarian, Abhinav Humar
1Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
Insights
Pediatric kidney transplantation is successful in infants, challenging the notion that younger children require delayed treatment. Early kidney transplants in infants yield results comparable to older children, improving developmental outcomes.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Organ Transplantation
Background:
- End-stage kidney disease (ESKD) in children necessitates renal replacement therapy.
- Kidney transplantation is the preferred treatment for pediatric ESKD.
- Historically, infants and young children have had lower transplant rates compared to older children.
Purpose of the Study:
- To evaluate the efficacy and outcomes of kidney transplantation in infants.
- To challenge the practice of delaying transplantation in infants based on age or size.
Main Methods:
- Review of over 50 kidney transplants performed in infant recipients at the center.
- Analysis of outcomes in relation to age, donor type (living adult donors), and timing of transplant (preemptive vs. non-preemptive).
- Focus on meticulous operative and perioperative care.
Main Results:
- Successful kidney transplantation outcomes in infants were demonstrated to be equivalent to those in older children.
- Early or preemptive transplantation in infants minimized the negative impacts of uremia on physical and neurological development.
- The use of adult kidneys from living donors was a key factor in successful outcomes.
Conclusions:
- Infant kidney transplantation is a viable and effective treatment option for end-stage renal disease.
- Transplant centers should not restrict transplantation based on infant size or age.
- Early transplantation in infants is crucial for optimizing long-term physical and neurological development.
Abstract:
Transplantation is now the preferred treatment for children with end-stage kidney disease. But not all pediatric age groups have enjoyed the same success. The number of transplants in infants and young children has lagged behind the number in older children. One reason for this is the philosophy of some centers to maintain infants on dialysis until they reach some arbitrarily determined age, at which time they would undergo a transplant. If kidney transplantation is the therapy of choice for older children with renal failure, and equivalent results can be obtained in all age groups, why should it not be offered to these youngest patients? Our center's philosophy for many years has been not to restrict transplant based on size or age. We have performed over 50 kidney transplants in infant recipients, and have shown equivalent results to those obtained in older children. Important factors in obtaining a successful outcome include the use of adult kidneys from a living donor, careful attention to operative and perioperative care, and performing the transplant early or in a preemptive fashion. The latter allows for minimizing the negative impact of uremia on physical and neurologic development in infants.
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