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Kidney transplantation in pediatric patients with rheumatologic disorders

Ellen Cody1, David K Hooper2

  • 1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center.

Current Opinion in Pediatrics
|December 26, 2021
PubMed

Insights

Children with end-stage kidney disease from rheumatologic conditions can undergo kidney transplantation. While recurrence is a risk, outcomes are generally good for most conditions, though lupus patients face worse results.

Area of Science:

  • Pediatric Nephrology
  • Rheumatology
  • Transplantation Immunology

Background:

  • Children with end-stage kidney disease (ESKD) from rheumatologic conditions require specialized care.
  • Key questions involve timing of kidney transplantation, recurrence risk, and management strategies.

Purpose of the Study:

  • To review recent developments and literature on kidney transplantation for pediatric ESKD caused by rheumatologic diseases.
  • To address post-transplant recurrence, outcomes, and prevention/treatment for common conditions.

Main Methods:

  • Literature review of recent developments and relevant studies.
  • Focus on systemic lupus erythematosus, IgA nephropathy, IgA vasculitis, and ANCA-associated vasculitis.

Main Results:

  • Children with IgA nephropathy, IgA vasculitis, and ANCA-associated vasculitis show similar graft survival post-transplant despite recurrence risk.
  • Systemic lupus erythematosus patients experience worse patient and allograft outcomes post-transplant.
  • Disease quiescence before transplantation may reduce recurrence risk, which is linked to poorer allograft survival.

Conclusions:

  • Kidney transplantation is viable for pediatric patients with systemic rheumatologic conditions.
  • Patients must be counseled on the risks of disease recurrence and its impact on transplant outcomes.
  • Limited data exist on preventive strategies and treatment for recurrent disease.
Abstract

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