A DBS assay was developed for tacrolimus and MPA. Tacrolimus venous concentrations could be adequately predicted from DBS. DBS analysis of MPA seemed to be a semiquantitative measurement at the most when compared with conventional plasma analysis, considering the high variability between observed and predicted concentrations. Next, home-based DBS sampling of tacrolimus for the purpose of therapeutic drug monitoring will be implemented into routine clinical care.

A randomised clinical trial was conducted to establish the effects of oral and intramuscular administration of vitamin K at birth on plasma concentrations ofvitamin K1, proteins induced by vitamin K absence (PIVKA-II), and clotting factors. Two groups of about 165 healthy breast fed infants who received at random 1 mg vitamin K1 orally or intramuscularly after birth were studied at 2 weeks and 1 and 3 months of age. Although vitamin K1 concentrations were statistically significantly higher in the intramuscular group, blood coagulability, activities of factors VII and X and PIVKA-II concentrations did not reveal any difference between the two groups. At 2 weeks of age vitamin K, concentrations were raised compared with reported unsupplemented concentrations and no PIVKA-II was detectable. At 3 months vitamin K1 concentrations were back at unsupplemented values and PIVKA-II was detectable in 11.5% of infants. Therefore, a repeated oral prophylaxis will be necessary to completely prevent (biochemical) vitamin K deficiency beyond the age of 1 month.

End-stage renal disease (ESRD) in children is rare with an incidence of 5-15 per million depending on geographic location. The best treatment option is kidney transplantation, which delays end-organ damage, enhances physical growth and improves quality of life. Advances in immunosuppressive therapy, surgical techniques and donor selection have improved both graft and patient survival over the last decades. Best outcomes are achieved with a pre-emptive transplantation (before the initiation of dialysis) from a living donor and at a young recipient age (<5 years). The resulting one-and five-year graft survival rates are then 99.5 and 94.9 percent, respectively. 1 Because of the low incidence of kidney transplantation in children and the complexities related to patient and surgery, care tends to be centralized in designated centers. Moreover, only 20% of pediatric kidney transplantations occur in recipients under the age of five, making it a rare procedure for the pediatric anesthesiologist to encounter. Notwithstanding, there is a clear lack of evidence-based guidelines resulting in diverse perioperative approaches. 2,3 The purpose of this review of recent literature is to describe the pathophysiological changes occurring in children with ESRD. In addition, we aim to provide recommendations and potential guidelines for anesthesia care in children undergoing either kidney transplantation or other surgical procedures in the presence of a donor kidney. | EPIDEMI OLOGYChildren account for less than 2% of all ESRD patients and about 5% of all kidney transplantations in Europe and North America. Kidney

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