Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study

Abstract

Background: Pediatric kidney transplantation was only introduced in Indonesia in 2013. We therefore aimed to assess the characteristics and outcomes of transplants performed from its inception to January 2019. Method: The study had a dual-center retrospective design. We examined the records of kidney transplant recipients and then calculated patient and graft survival rates by Kaplan-Meier survival analysis with 95% confidence intervals (95% CI). Results: In total, 12 kidney transplantations were performed in eleven children during the study period; among these, ten were boys, and nine had renal failure caused by congenital anomaly of the kidney or urinary tract. All donors were living, and all recipients were on dialysis at the time of transplantation, when their median age was 14.5 years (range, 8-19 years). Three patients died of infection in the first year of follow-up and two lost their allograft by the time of their last follow-up (median, 13 months; range, 4-69 months). The 1-year patient survival rate was therefore 68.18% (95% CI, 29.72%-88.61%), which remained unchanged at 3 and 5 years. However, the non-death-censored graft survival rates at 1, 3, and 5 years were 68.18% (95% CI, 29.72%-88.61%), 51.14% (95% CI, 14.5%-79.46%), and 25.57% (95% CI, 1.38%-64.78%), respectively. Conclusion: Patient and graft survival rates after pediatric kidney transplantation in Indonesia are lower than those reported in other countries. Closer patient follow-up and stricter adherence to guidelines could improve transplant outcomes, but we must seek to improve the balance between infection and rejection.

Epidemiology and Outcomes of Children with Kidney Failure Receiving Kidney Replacement Therapy in Australia and New Zealand

“…Moreover, KRT utilization has increased, particularly for KT. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 However, it remains uncertain whether similar patterns and outcomes have been achieved among the pediatric population, given that the etiologies of kidney failure in children are notably different from those in adults. 5 , 12 , 13 , 14 , 15 , 16 , 17 Since the 1980s, improved patient care and KRT policies have resulted in the acceptance of more challenging patients into pediatric KRT programs, including very young patients, and prioritization of pediatric patients with kidney failure as KT recipients.…”

High Fibroblast Growth Factor 23 as a Biomarker for Severe Cardiac Impairment in Children with Chronic Kidney Disease: A Single Tertiary Center Study

“…A recently published study from the pediatric kidney transplantation centers in Indonesia reported that all patients had hypertension and 42% of patients had cardiomyopathy before the kidney transplantation and the longest dialysis duration before the transplantation was 72 months. 14 About 86.05% of patients in our study had LVH with eccentric type. The eccentric LVH shows the addition of serial cardiac sarcomere and is associated with volume overload, causing thickening of the cardiac wall and enlargement of the left ventricular space.…”

Nephropathy in a Child with Severe Recessive Dystrophic Epidermolysis Bullosa Treated with Cyclophosphamide: A Case Report

“…Consistent with data from the largest epidermolysis bullosa (EB) registry [6], most reported cases progressed to kidney failure or death within 5 years of IgAN diagnosis. In contrast, only 5% of pediatric IgAN cases required kidney transplantation initially, and 20-25% of children with primary IgAN progressed to kidney failure within 20-30 years post-diagnosis [7][8][9]. Consequently, early detection and appropriate treatment of IgAN are crucial for RDEB patients [6].…”