Living donor kidney transplantation in pediatric recipients

Abstract

Living donor kidney transplantation has increased in frequency in pediatric patients, accounting for 43% of cases performed between 1987 and 1991, and 52% of cases performed between 1987 and 2004 in North America. Patient survival has remained excellent over the years, and is currently over 96% at five years. Graft survival has improved over the years, and is currently over 95% at one year. Rejection rates have fallen over the years, and are currently <25% overall, with selected centers having very low rejection rates. The reasons for these improved outcomes are likely related to improvements in maintenance immunosuppression, which include a transition from cyclosporine to tacrolimus-based regimens, and from azathioprine to mycophenolate mofetil or sirolimus as adjunctive agents. Steroid withdrawal and steroid avoidance are beginning to be utilized by several centers, with excellent early outcomes. Finally, while there may be center effect/learning curve issues involved, the type of donor nephrectomy has recently been shown to influence early outcomes, particularly in very young recipients.

Decreased Incidence of Acute Rejection in Adolescent Kidney Transplant Recipients Using Antithymocyte Induction and Triple Immunosuppression

“…This, too, is congruent with the review by Shapiro (19). It should be noted that in the NAPRTCS series, 19.6% of patients were rehospitalized for rejection in months 1-5 posttransplant (2).…”

“…One kidney was potentially lost to rejection during the first year and one death was observed after 1 year. This is a significant improvement over the results re- (19). An additional benchmark to compare the results of this study comes from the 2005 NAPRTCS Annual Report.…”

Effect of donor and recipient variables on the long-term live-donor renal allograft survival in children

“…These results were not confirmed by the multivariate regression analysis. NAPRTCS reported a decline in the use of cyclosporin A, anti-thymocyte globulin, OKT3 and anti-interleukin-2 receptor blockers, with increased use of tacrolimus, mycophenolate mofetil in addition to steroid-sparing regimens [27].…”

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“…The frequency of preemptive kidney transplant reported in other pediatric kidney transplant centers is 35% to 86%, and this procedure avoids the risks, cost, and related problems of dialysis and is associated with better graft survival and psychological and financial benefits than transplant after dialysis. 15 An increase in living-donor kidney transplant has been observed in some centers and has improved short-and long-term graft and patient survival. 16 The frequency of living donation varies in different regions including North America (60%), United Kingdom (25%), and Germany (18%), possibly because of variation in cultural and social attitudes and features of donation in the transplant programs.…”