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Published on: March 27, 2018
Challenges in pediatric renal transplantation in developing countries
S Adibul H Rizvi1, M Naqi Zafar, Ali A Lanewala
1Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
Insights
Pediatric kidney transplants in developing nations primarily involve older children and living related donors. High rates of rejection and infection lead to poor graft and patient survival outcomes.
Area of Science:
- Nephrology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Pediatric transplantation is a critical but under-resourced area in developing countries.
- Limited data exists on the outcomes and challenges of pediatric transplants in these regions.
Purpose of the Study:
- To review and synthesize findings from key reports on pediatric transplants in the developing world.
- To identify and highlight the challenges and outcomes associated with pediatric transplantation in these settings.
Main Methods:
- Systematic review of published literature on pediatric renal transplantation from developing countries.
- Analysis of transplant activity, donor/recipient demographics, immunosuppression protocols, and survival rates.
Main Results:
- Recent literature shows limited but ongoing pediatric renal transplant activity, with 11-300 transplants reported.
- High acute rejection rates (over 40% in 50% of series) and significant infection-related morbidity and mortality were observed.
- One-year graft survival ranged from 89-98%, and patient survival from 88-98%, with 5-year survival rates of 67-84% and 65-90%, respectively.
Conclusions:
- Pediatric transplantation in developing countries predominantly uses living related donors for older children.
- Challenges include high costs of immunosuppression leading to non-compliance, resulting in poor patient and graft survival due to rejection and infection.
Purpose Of Study:
The present review summarizes the findings of most important reports on pediatric transplants from the developing world and highlights the challenges and results of the activity.
Recent Findings:
In the past 3 years, 10 reports appeared in the literature on pediatric renal transplantation and further six more in the past 5 years. The experience ranges from 1 to 28 years for 11-300 transplants. Recipients were older than 6 years and donors were living relatives in more than 94% of the series. Cyclosporine, azathioprin and steroids are the mainstay of immunosuppression and in many centres the high costs of drugs resulted in noncompliance and discontinuation of immunosuppression. Therefore, acute rejection rates were high, more than 40% in half of the series. One-year and 5-year survival rates for grafts were 89-98% and 67-84% and for patients 88-98% and 65-90%, respectively. Major causes of graft loss were chronic rejection, acute rejection and infection and for the patients, it was infection. Growth analysis is not generally reported but when reported the deficit remains or gets worse.
Summary:
Pediatric transplantation activity in the developing world is limited to older children using mostly living related parental donors. High rejection and infection rates result in poor patient and graft survival.
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01:26Kidney Transplant II: Surgical Procedure
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01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism