Refractive Changes Associated With Pediatric Kidney Transplantation

Kidney transplantation remains the optimal treatment for children with end-stage renal disease (ESRD), 25%-40% of which are estimated to be caused by congenital malformations and genetic syndromes. Given the widespread nature of this surgical procedure, ocular complications may arise from the operation itself or from subsequent medical treatments. The aim of this study is to determine whether there are postoperative refractive changes in pediatric patients who have undergone kidney transplantation and to detect the presence of refractive changes that may cause amblyopia in patient follow-ups.

The electronic medical records of 1144 patients who underwent kidney transplantation at the Akdeniz University Hospital Organ Transplant Center between January 2019 and January 2024 were reviewed retrospectively. Of these, 84 pediatric patients who had undergone a complete ophthalmologic examination at least 1 year after kidney transplantation and had no missing data were included in the study. For both eyes, all data were recorded, including Best Corrected Visual Acuity (BCVA), refractive error (measured with the KR-8900; Topcon, Tokyo, Japan), spherical equivalent refractions (SER), slit-lamp examination of the anterior segment, and a dilated fundus examination.

The average age of patients who underwent kidney transplantation in the study is 13.01 ± 3.43 (6-18). The average follow-up period was 51.81 ± 33.5 (45-129) months. Thirty-five (41.7%) of the patients are female, and 49 (58.3%) are male. Cataracts were observed in 9 (10.7%) patients during follow-up after transplantation. Cataract development was observed on average in 5.6 years. Posterior subcapsular cataracts were observed in seven patients, cortical cataract in one patient, and anterior polar cataract in one patient. The mean preoperative visual acuity value in patients who developed cataracts after kidney transplantation was 0.00 logMAR, while it was measured as 0.19 logMAR in the postoperative period, and this decrease is statistically significant (p = 0.027). In patients who did not develop cataracts during the follow-up period, there was no statistically significant change in visual acuity in both eyes (p = 0.109). When all eyes are evaluated, the change in SER after kidney transplantation is not statistically significant compared with before (p = 0.689 for the right eye, p = 0.596 for the left eye).

Although children receive longer-term immunosuppressive treatment, their cataract development rates are lower than those of adults. Despite intensive and prolonged immunosuppression therapy after kidney transplantation, cataract development and refractive changes in the pediatric age group are at an acceptable level. Especially in children who are too young to express themselves clearly, monitoring refractive changes is crucial to prevent permanent vision loss.