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Renal transplantation in children: a comparative study between parental and well-matched cadaveric grafts
Insights
Parental kidney transplants in children show significantly better graft survival and fewer complications than cadaveric transplants. This highlights the benefits of living donor kidney transplantation for pediatric patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Organ Transplantation
Background:
- Pediatric kidney transplantation is crucial for end-stage renal disease.
- Comparing outcomes of living-related versus deceased-donor kidney transplants in children is essential.
Purpose of the Study:
- To compare the outcomes of parental (living-related) versus well-matched cadaveric kidney transplantation in children.
- To evaluate graft survival, patient survival, rejection rates, and post-transplant complications.
Main Methods:
- Retrospective review of 65 pediatric kidney transplant recipients (<15 years old) over 10 years.
- Comparison of 32 parental grafts (Group P) with 35 cadaveric grafts (Group C).
- Analysis of graft survival, patient survival, rejection episodes, and complications like osteonecrosis and hypertension.
Main Results:
- Significantly better graft survival in Group P (85.2%) vs. Group C (51.2%) at 5 years (P<0.02).
- Fewer graft losses due to rejection in Group P (2/3) compared to Group C (8/14) (P<0.01).
- Reduced incidence of acute rejection episodes, epiphyseal osteonecrosis, and hypertension in Group P.
Conclusions:
- Parental kidney transplantation in children yields superior graft survival and fewer complications compared to cadaveric transplants, even with good HLA-A,B matching.
- Improved outcomes in parental transplants may be due to better non-HLA compatibility and surgical factors.
- Living donor kidney transplantation is a favorable option for pediatric recipients.
Abstract:
We review our results of transplantation performed during the last 10 years in 65 children less than 15 years old: 32 parental grafts (group P) are compared with 35 grafts from well-matched (mean HLA-A,B mismatches: 1.7) cadavers (group C). Group P patients' survival is slightly but not significantly better than that of group C recipients (96.6 versus 82.7% at 5 years). Graft survival is significantly (P less than 0.02) better in group P than in group C (85.2 versus 51.2% at 5 years). At the end of the study, 3 grafts (2 from rejection) are lost in group P versus 14 (8 from rejection) in group C (P less than 0.01). The number of acute rejection episodes treated during the first 3 months is significantly lower in group P recipients. Epiphyseal osteonecrosis is observed in none of the patients of group P but in five of group C. Hypertension is significantly less frequent in group P than in group C. The results obtained in group P are attributed largely to a better non HLA-A,B compatibility, although the potential role of splenectomy performed in 25 recipients of group P and in none of group C cannot be excluded. Furthermore, the improved technical conditions inherent in living donor transplantation probably play an additional role. We conclude that in children the fate of parental kidneys is significantly better than that of cadaver transplants selected for their good HLA-A,B compatibility.