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Growth and development in infants after renal transplantation
Insights
Early living related renal transplantation significantly improves growth and development in infants with end-stage renal disease. This vital procedure offers a promising option, leading to better long-term outcomes for young patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Growth and Development
Background:
- Infants with end-stage renal disease (ESRD) often experience significant growth and developmental delays.
- Early intervention is crucial for improving long-term outcomes in pediatric ESRD.
Purpose of the Study:
- To evaluate the long-term growth and developmental outcomes in infants following primary renal transplantation.
- To assess the efficacy of living related donor renal transplantation in this population.
Main Methods:
- Analysis of growth parameters (height, head circumference) and developmental assessments (mental, motor) in nine infants post-transplant.
- Longitudinal follow-up ranging from 4 months to 7.5 years after transplantation.
Main Results:
- Significant improvements in height standard deviation scores were observed in boys (+1.4 SDS, P < 0.05).
- All surviving children achieved normal head circumference (mean improvement +2.2 SDS, P < 0.001).
- Post-transplant, all infants showed normal mental development, and 71% demonstrated normal motor development.
Conclusions:
- Early living related renal transplantation is a viable and effective option for managing ESRD in infants.
- Transplantation leads to substantial improvements in physical growth and neurodevelopmental outcomes.
- This approach offers a pathway to improved quality of life for infants with kidney failure.
Abstract:
Between January 1, 1978, and August 31, 1985, 13 infants aged 6 to 11 months received primary renal transplants (12, living related donor; one cadaver) at the University of Minnesota. Twelve infants are alive with functioning grafts (10 primary and two second transplants) after 4 months to 7.5 years. To assess the long-term outcome, we analyzed growth and development in the first nine infants 2 to 7.5 years after receiving their first transplant. Before transplantation, head circumference and height standard deviation scores in six of nine infants were less than -2. Five had seizures; four had delayed mental development, and six delayed motor development. The mean increment in height standard deviation scores for six boys after transplantation was +1.4 (P less than 0.05), and one achieved complete catch-up growth. The mean difference in height standard deviation scores for three infant girls with primary hyperoxaluria was -2.1; nevertheless, two infants with oxalosis are currently alive 2.7 to 3.3 years later. All eight surviving children achieved normal head circumference (mean improvement +2.2 SDS, P less than 0.001), and no child had further seizures. Of seven infants reassessed with the Bayley Scales after transplantation, mental development was normal in all and motor development was normal in five. Our findings suggest that early living related renal transplantation is an important option in the management of end-stage renal disease in infants.