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Dialysis and renal transplantation in children: long term and recent experience
D J Lewis1, M McIver, D F Scott
1Victorian Paediatric Dialysis and Transplant Unit, Monash Medical Centre, Clayton, Victoria, Australia.
Insights
Pediatric end-stage renal failure patients achieved excellent survival rates with dialysis and renal transplantation. The comprehensive pediatric program improved graft survival and enabled good educational and employment outcomes.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Transplantation Medicine
Background:
- End-stage renal failure (ESRF) in children presents significant challenges.
- Historically, pediatric ESRF care was integrated into adult programs.
- A dedicated pediatric program was established in 1985.
Purpose of the Study:
- To report the long-term outcomes of children with ESRF.
- To evaluate the effectiveness of a comprehensive pediatric dialysis and transplantation program.
- To assess patient survival, graft survival, and psychosocial development.
Main Methods:
- Retrospective analysis of 38 children with ESRF over 16 years.
- Comparison of outcomes before and after the implementation of a dedicated pediatric program in 1985.
- Data collection on patient survival, dialysis modality, graft survival, and psychosocial outcomes.
Main Results:
- Patient survival rates of 97%, 86%, and 80% at 1, 5, and 10 years, respectively.
- Continuous ambulatory peritoneal dialysis was the preferred dialysis method.
- Primary cadaveric graft survival improved significantly post-1985, reaching 90% at 1 year.
- Major long-term issues included growth failure and social development, though 87% attended normal schooling and 78% of those who left school were employed or in higher education.
Conclusions:
- Dialysis and renal transplantation offer excellent survival for children with ESRF.
- A comprehensive pediatric program significantly enhances graft survival rates.
- Successful renal replacement therapy facilitates satisfactory educational and employment achievements in pediatric ESRF patients.
Abstract:
The outcome of 38 children with endstage renal failure who entered a dialysis and renal transplant programme over a period of 16 years is reported. The initial care was given in an adult programme but in 1985 this was changed to a comprehensive and specifically paediatric programme. Patient survival was 97, 86 and 80% at 1, 5 and 10 years respectively. Thirty-four of the patients spent a mean period of 19 months (range 1-160 months) on dialysis with the preferred form of dialytic therapy being continuous ambulatory peritoneal dialysis. Primary cadaveric graft survival was 72 and 42% at 1 and 3 years respectively; although since 1985 1 year graft survival has risen to 90%. The major long term problems have been growth failure and poor social development. Eighty-seven per cent of children have been able to continue normal schooling, and of the 18 who have left school 14 (78%) are employed or undertaking tertiary education. Thus dialysis and transplantation has allowed not only excellent patient survival but also the achievement of satisfactory educational standards and subsequent employment for the majority of patients.