Related Experiment Videos
Kidney graft loss in children: implications for program development
J F Crocker1, A W Wade, A T McDonald
1Department of Pediatrics, Dalhousie University, Halifax, NS.
Summary
Pediatric kidney transplant graft survival improved significantly with a new protocol. Enhanced surveillance and early treatment of rejection and infection are key to better outcomes in pediatric kidney transplantation.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Medicine
Background:
- Pediatric kidney transplant graft survival rates are historically lower than in adults.
- The IWK-Grace Health Centre's pediatric kidney transplant program aimed to improve outcomes.
- A review of 22 years of operation was conducted to identify areas for improvement.
Purpose of the Study:
- To review the 22-year experience of a regional pediatric kidney transplantation unit.
- To identify factors affecting graft survival in pediatric kidney transplant recipients.
- To implement changes to improve graft survival rates.
Main Methods:
- Retrospective review of kidney transplants performed between 1971 and 1992.
- Analysis of first transplant data compared to North American databases.
- Implementation of a sequential immunosuppression protocol, increased medical surveillance, a dedicated pediatric team, and specific donor criteria after 1992.
Main Results:
- Graft survival rates at 1, 2, and 5 years showed dramatic improvement after program changes.
- Post-1993, only 2 graft losses occurred among 22 transplants, with one due to recurrent disease.
- Rejection episodes were effectively managed with high-dose steroid therapy.
Conclusions:
- A sequential immunosuppression protocol significantly enhances pediatric kidney graft survival.
- Close medical surveillance and prompt treatment of rejection and infection are crucial.
- Programmatic changes led to marked improvements in pediatric kidney transplant outcomes.