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Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies
B Bañuelos Marco1, M I Dönmez2, T Geppert3
1Departamento de Urología, Unidad de Trasplante Renal, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Insights
Pediatric kidney transplantation requires specialized preoperative evaluation, focusing on congenital anomalies and urinary tract issues. Optimal management ensures improved short and long-term outcomes for child recipients.
Area of Science:
- Pediatric Nephrology
- Urology
- Transplantation Medicine
Background:
- Pediatric renal transplantation presents unique challenges compared to adult recipients.
- This review focuses on the specific considerations for pediatric kidney transplant recipients.
Purpose of the Study:
- To provide an educational review of the preoperative evaluation for pediatric kidney transplantation.
- To address unique aspects of managing congenital urogenital anomalies and lower urinary tract dysfunction in this population.
Main Methods:
- A narrative review of literature published between January 2000 and October 2022.
- Searches conducted on PubMed, WHO/UNAIDS, Google-Scholar, Semantic-Scholar, and Research Gate.
- Prioritization of high-quality studies including RCTs, meta-analyses, and systematic reviews.
Main Results:
- Discusses management of congenital urogenital anomalies and lower urinary tract dysfunction.
- Addresses pre-emptive transplantation and transplantation of adult-sized kidneys into small children.
- Highlights the importance of optimal pediatric urological preoperative assessment.
Conclusions:
- Outcomes for pediatric renal transplantation have significantly improved.
- Living related donor transplantation and pre-emptive transplantation yield the best results.
- Comprehensive pre- and post-transplant surgical and medical management is crucial for pediatric kidney recipients.
Introduction And Objective:
Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient.
Material And Methods:
A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines).
Results:
Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed.
Conclusions:
Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results.
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