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Published on: April 12, 2021
Long-term effects of paediatric kidney transplantation
Christer Holmberg1, Hannu Jalanko1
1Department of Paediatric Nephrology &Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbäckinkatu 11, PO BOX 281, Helsinki, FI-00290, Finland.
Insights
Pediatric kidney transplants offer good short-term success, enabling normal growth. However, long-term outcomes require managing immunosuppression side effects to prevent complications and ensure graft survival.
Area of Science:
- Nephrology
- Pediatric Surgery
- Immunology
Background:
- Renal transplantation in children generally yields positive short- and medium-term outcomes.
- Early diagnosis and treatment of chronic kidney disease (CKD) and end-stage renal disease (ESRD) support normal growth and development post-transplant.
Purpose of the Study:
- To review the outcomes and long-term effects of renal transplantation in pediatric recipients.
- To discuss consequences on growth, development, bone health, metabolic disorders, and cardiovascular health.
- To identify challenges in managing pediatric renal transplant recipients and areas for future research.
Main Methods:
- This is a review article, synthesizing existing literature on pediatric renal transplantation.
- The review focuses on analyzing outcomes, long-term effects, and complications.
Main Results:
- While short-term results are excellent, long-term outcomes can be affected by immunosuppressive medication adverse effects and reduced graft function.
- Potential long-term complications include metabolic disorders, cardiovascular disease, poor bone health, and malignancies.
- Neurocognitive development and quality of life are significantly influenced by the primary diagnosis and graft function.
Conclusions:
- Managing immunosuppression and graft function is crucial for optimizing long-term health in pediatric renal transplant recipients.
- Adherence to immunosuppression is vital, especially in adolescents, highlighting the need for a smooth transition to adult care.
- Further research should address key challenges to improve long-term care and outcomes for these patients.
Abstract:
Renal transplantation in paediatric patients usually provides excellent short-term and medium-term results. Early diagnosis of chronic kidney disease and active therapy of end-stage renal disease before and after transplantation enables the majority of children to grow and develop normally. The adverse effects of immunosuppressive medication and reduced graft function might, however, hamper long-term outcomes in these patients and can lead to metabolic complications, cardiovascular disease, reduced bone health, and malignancies. The neurocognitive development and quality of life of paediatric transplant recipients largely depend on the primary diagnosis and on graft function. Poor adherence to immunosuppression is an important risk factor for graft loss in adolescents, and controlled transition to adult care is of utmost importance to ensure a continued normal life. In this Review, we discuss the outcomes and long-term effects of renal transplantation in paediatric recipients, including consequences on growth, development, bone, metabolic, and cardiovascular disorders. We discuss the key problems in the care of paediatric renal transplant recipients and the remaining challenges that should be the focus of future research.
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