Long‐term outcome of pediatric renal transplantation: The Norwegian experience in three eras 1970–2006

Abstract

During the years 1970-2006, 251 renal transplantations were performed in 178 children in Norway. The proportion of LD was 84%. Transplantations were performed preemptively in 52%. Pretransplant dialysis time was median three months. Structural abnormalities and hereditary renal disorders constituted 69% of end-stage renal diseases, 29% were caused by glomerulopathies and other acquired disorders and 2% of unknown cause. Patient survival rates were 94.2, 93.5, and 84.4% at five, 10, and 20 yr, respectively. The most frequent cause of death was infections followed by cardiovascular events. For recipients of living donor grafts (n = 149), survival of first transplant was 82, 68.8, and 45.1% at five, 10, and 20 yr, respectively, and was significantly higher than for recipients of deceased donor organs (n = 29; log rank, p = 0.008). The only significant predictor for better transplant survival when modeled with multiple regression analysis adjusted for pretransplant dialysis, diagnosis, donor age, sex and immunosuppressive era, was the use of LD compared with DD (HR = 2.1, 95% CI [1.1-4.0], p = 0.02). The acute rejection rate declined significantly from 61.5% in 1970-1982 to 14.5% in 2000-2006 (log rank, p = 0.002). It remains to be seen whether the reduction in acute rejection rate and present immunosuppressive therapy will have a positive impact on long-term graft survival in years to come.

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

“…Except for children less than 5 years old at TX [3], patient survival has not increased substantially in the last three decades [4,5]. Concern has therefore turned toward reducing the long-term mortality risk that TX children face in adulthood in terms of cardiovascular disease (CVD), comprising 30-50% of deaths post-transplantation [4,6,7].…”

Solid-Organ Transplantation in Childhood: Transitioning to Adult Health Care

“…10 Advances in surgical and organ-preservation techniques, improved immunosuppressive and antiviral regimens, and changes in donor-organ allocation have improved the success rates of solid-organ transplantation. [11][12][13] Transplantation, in essence, replaces end-stage disease with a more sustainable chronic disease state, and its consequences have substantial clinical and psychosocial implications. The process of transitioning itself can be mired by complications that result from solid-organ transplantation.…”

Overview of pediatric organ transplantation

“…Chronic kidney disease of multifactorial cause may occur after all pediatric solid-organ transplantation [54,55]. Infectious disease is a major source of morbidity and mortality in all forms of pediatric solid-organ transplantation [56,57]. Malignancy is a significant problem faced by pediatric recipients of solid-organ transplants [58].…”