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10 years' experience with regular haemodialysis and renal transplantation
Insights
Pediatric renal replacement therapy, including hemodialysis and transplantation, offers encouraging outcomes for children with end-stage renal disease. Successful transplants improve growth, psychosocial well-being, and rehabilitation compared to long-term dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Organ Transplantation
Background:
- End-stage renal disease (ESRD) in children presents significant challenges.
- Established a pediatric regular hemodialysis/renal transplant program over 10 years.
- 13 of 75 pediatric patients died during the study period.
Purpose of the Study:
- To evaluate the outcomes of a combined hospital and home hemodialysis and renal transplantation program for children with ESRD.
- To assess graft survival rates and patient survival.
- To compare the long-term benefits of successful transplantation versus long-term dialysis.
Main Methods:
- Retrospective analysis of 75 children under 15 years undergoing regular hemodialysis or renal transplantation.
- Utilized a combination of hospital and home hemodialysis and renal transplantation.
- Collected data on patient survival, graft survival (live-related and cadaver donors), and post-transplant outcomes.
Main Results:
- Overall 5-year actuarial patient survival was 76%.
- Live-related donor graft survival was 65% at 3 years and 55% at 5 years; 1st cadaver graft survival was 42% at 3 years.
- Improved graft survival rates observed in the latter 6 years of the study period.
- Children with successful transplants showed better growth, fewer psychosocial issues, and improved rehabilitation compared to those on dialysis.
Conclusions:
- Dialysis and renal transplantation are viable and encouraging options for children with ESRD.
- Successful renal transplantation significantly enhances quality of life, growth, and psychosocial adjustment in pediatric patients.
- The program demonstrated particular success with home hemodialysis and live-related donor transplantation.
Abstract:
75 children aged under 15 years have entered the regular haemodialysis/renal transplant programme at Guy's Hospital in the 10 years since its inception; 13 children have subsequently died. A combination of hospital and home haemodialysis and renal transplantation was used. 64 children received 80 renal allografts; 37 1st grafts were from live, related donors and 27 were from cadaver donors. The 5-year acturial patient survival for the whole group and for those who had transplants was 76%. Live donor graft survival was 65% at 3 years, and 55% at 5 years; 1st cadaver graft survival was 42% at 3 years. Results obtained during the last 6 years of the 10-year period showed an improvement with a live related donor graft survival rate of 71%, and a 1st cadaver graft survival rate of 47% at 3 years. Particular experience was gained with home haemodialysis and live, related donor transplantation. Despite growth, and psychosocial and rehabilitation problems, the overall results were encouraging, particularly for the 46 children who had successful transplants. These children grew better, had fewer psychosocial difficulties, and were rehabilitated more successfully into normal life than those on long-term dialysis. We conclude that dialysis and transplantation should be offered to all suitable children with terminal renal failure.