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Published on: April 12, 2021
Evaluation and post-transplant management of children after multi-organ-with-kidney transplantation
Rachel M Engen1, Caroline P Lemoine2
1Department of Pediatrics, University of Wisconsin Madison, Madison, WI, USA. rengen@wisc.edu.
Insights
Pediatric multi-organ transplantation, often including a kidney, is a rare but life-saving procedure for children with complex diseases. This review covers indications, evaluation, and management, highlighting research gaps.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Nephrology
Background:
- Multi-organ transplantation involves receiving two or more organs from a single donor.
- It is uncommon in pediatric cases but vital for children with rare diseases causing multi-organ failure.
- Kidney failure is frequently a secondary complication in these pediatric cases.
Purpose of the Study:
- To review the current status of pediatric multi-organ transplantation that includes a kidney.
- To focus on the indications, evaluation, and management differences compared to kidney-only transplants.
- To identify areas requiring further research due to a lack of existing guidelines.
Main Methods:
- Literature review of reported statistics.
- Synthesis of peer-reviewed expert opinion.
- Analysis of current practices in pediatric multi-organ transplantation.
Main Results:
- Pediatric multi-organ transplantation is indicated for conditions like heart, liver, pancreas, or intestinal failure with secondary kidney involvement.
- Management differs significantly from kidney-alone transplantation.
- No established guidelines or consensus statements currently exist for this procedure.
Conclusions:
- Pediatric multi-organ transplantation is a critical intervention for specific complex pediatric conditions.
- Further research is essential to develop evidence-based guidelines for indications, evaluation, and management.
- Standardization of care is needed to improve outcomes for these challenging cases.
Abstract:
Multi-organ transplantation involves the transplant of two or more organs from a single donor into a single recipient; in most cases, one of these organs is a kidney. Multi-organ transplantation is uncommon in pediatric transplantation but can be life-saving or significantly life-improving for children with rare diseases, including primary heart, liver, pancreas, or intestinal failure with secondary kidney failure, metabolic disorders, and genetic conditions causing multi-organ dysfunction. This manuscript reviews the current state of pediatric multi-organ transplantation that includes a kidney, with a focus on indications, evaluation, and key differences in management compared to kidney-alone transplantation. Guidelines and consensus statements for pediatric multi-organ transplantation are nonexistent; this review condenses reported statistics and peer-reviewed expert opinion while highlighting areas in need of further research.
