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[Renal transplantation in the child]
1Service de Néphrologie Pédiatrique, Hôpital des Enfants-Malades, Paris.
Insights
Pediatric kidney transplantation has excellent survival rates, with nearly 100% patient survival since 1985, especially with cyclosporine. This improves quality of life and growth in children with renal grafts.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Surgical Innovation
Context:
- In Europe, by Dec 31, 1986, 50% of 1,616 registered children (<15 years) had functional renal grafts.
- Living donor transplants (5%) bypassed pre-transplant dialysis, while brain-dead donor recipients often faced long dialysis waits.
- Recipient preparation, legal aspects, and selection criteria for cadaveric kidney grafts in children were detailed.
Purpose:
- To review the process and outcomes of kidney transplantation in pediatric patients.
- To highlight the impact of cyclosporine on graft survival and patient well-being.
- To discuss surgical techniques, perioperative care, and long-term results, including rehabilitation and growth.
Summary:
- Renal transplantation in children has shown remarkable improvement since 1985, with nearly 100% patient survival attributed to cyclosporine.
- Second transplantations after graft failure yield comparable or superior results.
- Cyclosporine therapy also offers better statural growth prospects compared to older immunosuppressors.
Impact:
- Improved long-term quality of life, rehabilitation, and social/professional integration for pediatric kidney transplant recipients.
- Enhanced growth potential in children undergoing renal transplantation with modern immunosuppressive regimens.
- Established kidney transplantation as a highly successful treatment for pediatric end-stage renal disease.
Abstract:
The informations available for Europe show that, on December 31, 1986, 50% of the 1,616 registered children under 15 years of age had a functional renal graft. Only 5% of these children had been transplanted without prior dialysis, which is usually possible only with a graft taken from a living donor. With brain-dead donors, generally adults, numerous patients may remain on the waiting list after several years of dialysis. The preparation of recipients, the juridical aspects of such transplantations in children, the principles of selection of recipients for corpse kidney grafts are reported. The technical aspects of graft surgery and the per- and postoperative supervision are then reported. The results of renal transplantation have improved since the advent of cyclosporine: patients' survival remains almost 100% on the whole of the renal transplantations performed in children since 1985. The results obtained with a second transplantation after failure of the first are comparable and sometimes better in some series. Finally, the quality of everyday life of the grafted child, its rehabilitation after transplantation, its social and professional insertion are emphasized. Furthermore, the possibilities of statural growth under cyclosporine therapy are better than those when one could use only traditional immunosuppressors.