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Pediatric renal transplantation

A Singh1, L Cortes, A Tejani

  • 1SUNY Health Science Center at Brooklyn, New York, USA.

Current Opinion in Nephrology and Hypertension
|November 1, 1995
PubMed
Summary

Pediatric renal transplantation survival rates have improved, but acute rejection remains a challenge in young children. Further research is needed to understand and mitigate rejection, and to optimize growth post-transplant.

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Area of Science:

  • Pediatric Nephrology
  • Transplant Immunology
  • Growth Hormone Therapy

Background:

  • Renal transplantation is a primary treatment for pediatric end-stage renal disease.
  • Survival rates for pediatric kidney transplants have significantly improved.
  • Acute rejection remains a critical issue, particularly in younger children.

Purpose of the Study:

  • To analyze trends and outcomes in pediatric renal transplantation.
  • To investigate mechanisms of heightened immune response and acute rejection in young children.
  • To evaluate the necessity and safety of growth hormone therapy post-transplant.

Main Methods:

  • Analysis of a large dataset from North American Pediatric Renal Transplant Cooperative Study.
  • Utilizing surveillance biopsies to identify molecular mediators of acute rejection.
  • Longitudinal studies on growth patterns after transplantation.

Main Results:

  • 1- and 2-year graft survival rates for cadaveric donor pediatric renal transplants increased from 72% and 65% (1987) to 83% and 78% (1991).
  • Graft failure due to acute irreversible rejection disproportionately affects children under 6 years old.
  • Catch-up growth post-transplant is inconsistent, often necessitating recombinant growth hormone intervention.

Conclusions:

  • While graft survival has improved, acute rejection in young children requires further investigation.
  • Recombinant growth hormone may be necessary for optimal growth but requires controlled trials due to potential chronic rejection concerns.

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