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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
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Native nephrectomy in pediatric transplantation--less is more!

Nia Fraser1, P C Lyon, A R Williams

  • 1Department of Paediatric Urology, Kidney Transplant Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK. nia.fraser@nuh.nhs.uk

Journal of Pediatric Urology
|January 10, 2012
PubMed
Summary

Pre-transplantation native nephrectomy (PTNN) was performed in 10.3% of pediatric renal transplant candidates, primarily for proteinuria and infection. Excluding malignancies, PTNN was done in 8.4% of children, showing favorable graft function post-transplant.

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Area of Science:

  • Pediatric Nephrology
  • Transplant Surgery
  • Urology

Background:

  • Pre-transplantation native nephrectomy (PTNN) is indicated for various conditions including infection, proteinuria, hypertension, polycystic kidneys, and malignancy.
  • Determining the frequency and specific indications for PTNN in pediatric renal transplant recipients is crucial for optimizing patient management.

Purpose of the Study:

  • To establish the frequency and primary indications for pre-transplantation native nephrectomy (PTNN) in children undergoing renal transplantation.
  • To evaluate the outcomes of PTNN and subsequent renal transplantation in pediatric patients.

Main Methods:

  • A retrospective analysis of children listed for renal transplant between 1998 and 2010 who underwent PTNN.
  • Data collected included etiology of renal failure, indication for nephrectomy, CKD stage, complications, and transplant timing.
  • Outcomes of transplanted children and native kidney preservation post-transplant were reviewed.

Main Results:

  • 21 out of 203 (10.3%) children underwent PTNN (32 nephrectomies).
  • Primary indications were drug-resistant proteinuria (6), recurrent urosepsis (6), refractory hypertension (4), and malignancy (4).
  • 19/21 children were transplanted, with 17 achieving stable graft function; only 2 non-PTNN patients required post-transplant nephrectomy.

Conclusions:

  • PTNN was performed in a minority of pediatric renal transplant candidates (8.4% excluding malignancies), mainly for proteinuria.
  • PTNN in this cohort was associated with reduced morbidity and favorable subsequent graft function.
  • Careful patient selection for PTNN can lead to positive outcomes in pediatric renal transplantation.