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Pediatric renal transplantation--Indian experience
K Phadke1, S Ballal, K Venkatesh
1Department of Pediatrics, Manipal Hospital, Bangalore.
Insights
Pediatric renal transplantation in India is a viable option for end-stage renal disease (ESRD). This study found acceptable graft survival rates and successful patient rehabilitation, demonstrating its global comparability.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Immunology
Background:
- End-stage renal disease (ESRD) in children presents significant challenges.
- Renal transplantation is a critical treatment option for pediatric ESRD.
- Limited data exists on pediatric renal transplantation outcomes in India.
Purpose of the Study:
- To analyze the experience and outcomes of renal transplantation in children with ESRD in India.
- To evaluate graft survival and patient rehabilitation post-transplantation.
- To assess the feasibility of pediatric renal transplantation in a developing country context.
Main Methods:
- Retrospective study of 27 pediatric renal transplants performed over 7.5 years.
- Patients were categorized by age (<6 years and 6-12 years) and underlying renal disease (glomerular vs. tubulointerstitial).
- Surgical approaches (transperitoneal/extraperitoneal) and triple immunosuppression (Cyclosporine, Azathioprine, Steroids) were detailed.
Main Results:
- Follow-up ranged from 6 months to 7.5 years (mean 3.7 years).
- Graft survival rates were 73.2% at one year and 71% at two years.
- Ten episodes of acute rejection occurred, with three refractory cases; no surgical complications were reported.
Conclusions:
- Renal transplantation in Indian children with ESRD is an acceptable treatment modality.
- The study demonstrates comparable outcomes to global standards.
- Successful transplantation leads to satisfactory patient rehabilitation.
Objective:
To analyze our experience with renal transplantation in children with end-stage renal disease (ESRD) in India.
Design:
Retrospective study.
Methods:
Over the last 7.5 years, 27 renal transplants were performed on children below 12 years of age, 8 children were less than 6 years old, 19 were between 6 and 12 years of age. Sixteen children had underlying glomerular disease while eleven had tubulointerstitial renal disease. Transperitoneal approach was used in smaller recipients weighing less than 12 kg. Extraperitoneal approach was used in the remainder. Triple immunosuppression with Cyclosporine, Azathioprine and Steroids was used in all cases.
Results:
Follow-up period ranged from 6 months to 7.5 years (mean 3.7 years). There were 10 episodes of acute rejection. Three cases of acute rejection failed to respond to therapy. No surgical complications were encountered. Graft survival was 73.2% at one year and 71% at two years. Satisfactory rehabilitation was achieved in children with functioning grafts.
Conclusions:
Renal transplantation in children in India offers an acceptable choice in ESRD as anywhere in the world.