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Severe intellectual disability is not a contraindication to kidney transplantation in children

Ashton Chen1, Alan Farney2, Gregory B Russell3

  • 1Department of Pediatrics, Wake Forest Baptist Health, Winston-Salem, NC, USA.

Pediatric Transplantation
|February 2, 2017
PubMed

Insights

Pediatric kidney transplants for children with intellectual disability (ID) show promising results. Graft survival and rejection rates were similar to those without ID, suggesting they are suitable candidates with support.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Developmental Disabilities

Background:

  • Renal transplantation in children with intellectual disability (ID) is debated due to limited outcome data.
  • Varying program acceptance criteria restrict access for these pediatric patients.
  • Cognitive impairment in pediatric renal transplant recipients impacts candidacy and outcomes.

Purpose of the Study:

  • To evaluate graft survival and acute rejection rates in pediatric renal transplant recipients with and without intellectual disability.
  • To assess the safety and efficacy of renal transplantation in children with ID.
  • To inform candidacy criteria for pediatric renal transplantation.

Main Methods:

  • Retrospective chart review of 72 pediatric renal transplant recipients (2002-2012).
  • Patients categorized into two groups: those with pre-existing intellectual disability (ID, n=10) and those without (non-ID, n=62).
  • Kaplan-Meier estimates used to compare graft survival and biopsy-proven acute rejection (BPAR) episodes.

Main Results:

  • Three-year graft survival rates were 100% in the ID group versus 80% in the non-ID group (P=.13).
  • Three-year BPAR rates were 10% in the ID group compared to 27% in the non-ID group (P=.29).
  • Graft survival and acute rejection-free survival rates were comparable between the two groups.

Conclusions:

  • Midterm outcomes indicate no contraindication for renal transplantation in pediatric patients with ID.
  • Children with ID demonstrate similar graft survival and acute rejection rates post-transplant compared to peers without ID.
  • Pediatric patients with ID should be considered for renal transplantation, contingent upon adequate social support.

Keywords:
disabilitygraft survivalkidney transplant

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