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Related Experiment Videos

Progress in renal transplantation for children

R A McDonald1, S L Watkins

  • 1Division of Nephrology, Children's Hospital and Medical Center, University of Washington, Seattle 98105, USA.

Advances in Renal Replacement Therapy
|January 1, 1996
PubMed
Summary

Pediatric renal transplantation aims to treat end-stage renal disease, considering various patient factors. While outcomes improve, pediatric transplant results still trail those of young adults, highlighting ongoing challenges in pediatric kidney transplant care.

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Area of Science:

  • Nephrology
  • Pediatric Surgery
  • Immunology

Background:

  • End-stage renal disease (ESRD) in children necessitates renal transplantation as the primary treatment.
  • Successful pediatric kidney transplantation requires careful consideration of numerous patient-specific factors.

Purpose of the Study:

  • To outline key considerations for optimizing pediatric renal transplantation timing and management.
  • To review current and emerging immunosuppressive therapies for pediatric kidney transplant recipients.
  • To identify persistent challenges and compare outcomes in pediatric versus adult renal transplantation.

Main Methods:

  • Review of factors influencing pediatric renal transplant timing, including age, disease etiology, psychosocial status, donor type, and growth parameters.

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  • Assessment of pre-transplant immunizations and infectious disease screening (Epstein-Barr virus, cytomegalovirus, HIV, hepatitis A, B, C) for donor and recipient.
  • Evaluation of standard immunosuppressive agents (prednisone, imuran, cyclosporine, T cell antibodies) and novel investigational therapies (FK-506, rapamycin, mofetil, brequinar, leflunomide, HLA-derived peptides).

    • Main Results:

    • Key factors for determining optimal transplant timing include patient age, primary renal disease, psychosocial status, donor type, and growth status.
    • Comprehensive immunizations and infectious disease screening are critical pre-transplant steps.
    • Established immunosuppressants form the current standard, with several novel agents under investigation.
    • Infection, rejection, and malignancy remain significant complications in pediatric renal transplantation.
    • Despite improvements, pediatric renal transplant outcomes still lag behind those observed in young adults.

    Conclusions:

    • Optimizing pediatric renal transplantation involves a multidisciplinary approach addressing patient-specific factors and potential complications.
    • Ongoing research into novel immunosuppressive therapies may improve outcomes, but challenges persist.
    • Pediatric kidney transplant recipients require specialized long-term management to bridge the gap in outcomes compared to adult recipients.