Outcomes of underweight, overweight, and obese pediatric kidney transplant recipients

The field of pediatric kidney transplantation remains challenging due to an ongoing lack of size‐matched grafts and anatomical peculiarities. In the current study, we investigated the incidence of surgical complications in pediatric recipients, with a focus on risk factors and effects on graft outcome. We retrospectively reviewed all 2386 kidney transplantations at our institution from January 2005 until December 2018. Of these, 221 transplants were performed in pediatric recipients, defined as under the age of 18 years. Donor‐recipient body surface area ratios were calculated to evaluate the effects of size mismatching. Regression analyses were performed to identify independent risk factors for surgical complications and graft survival, respectively. Perioperative surgical complications requiring revision were observed in 34 (15.4%) cases. Leading cause for revision were vascular complications such as thrombosis or stenosis (n = 15 [6.8%]), which were significantly more frequent in case of young donors, (ie, donor age <6 years; OR: 4.281; CI‐95%:1.385‐13.226; P = .012), previous nephrectomy (OR: 3.407; CI‐95%:1.019‐11.387; P = .046), and en‐bloc grafts (OR: 4.923; CI‐95%:1.355‐17.884; P = .015), followed by postoperative hemorrhage (n = 10 [4.5%]), ureteral complications (n = 8 [3.6%]), and lymphoceles (n = 7 [3.2%]). Median follow‐up was 84.13 (0.92‐175.72) months. One‐, 5‐, and 10‐year graft survival rates were 97.1%, 88.9%, and 65.1%, respectively. Except for vascular complications (HR: 4.727; CI‐95%:1.363‐16.394; P = .014), none of the analyzed surgical morbidities significantly influenced graft survival. In conclusion, pediatric kidney transplantation achieves excellent long‐term results. However, meticulous surgical technique and continuous postoperative monitoring are imperative for early detection and treatment of imminent vascular complications, especially in case of young donors and en‐bloc grafts.

Section: Discussionmentioning

confidence: 99%

Surgical complications in pediatric kidney transplantation—Incidence, risk factors, and effects on graft survival: A retrospective single‐center study

Beetz

Weigle

Nogly

et al. 2020

“…Delayed graft function (DGF) was defined as a requirement of dialysis within first‐week post‐transplant. Prolonged hospitalization was defined as hospital length of stay greater than 14 days, chosen a priori based on previous studies 19–21 …”

Section: Methodsmentioning

confidence: 99%

“…Prolonged hospitalization was defined as hospital length of stay greater than 14 days, chosen a priori based on previous studies. [19][20][21]…”

Section: Transplant Outcomesmentioning

confidence: 99%

Kidney transplant outcomes in children and adolescents with systemic lupus erythematosus

Mai

Singer

Fahmy

et al. 2021

Self Cite

Background: Literature supports equivalent kidney transplant outcomes in adults with systemic lupus erythematosus (SLE) compared with those without SLE. However, there are conflicting and scant data on kidney transplant outcomes, as well as controversy over optimal timing of transplantation, in children and adolescents with SLE. Methods: Analysis included kidney-only transplant recipients aged 2-21 years from 2000 to 2017 enrolled in the Organ Procurement and Transplant Network (OPTN). The relationship between diagnosis (SLE n = 457, non-SLE glomerular disease n = 4492, and non-SLE non-glomerular disease n = 5605) and transplant outcomes was evaluated. The association between dialysis time and outcomes was analyzed in the SLE group only. Results:In adjusted models, SLE had higher mortality compared with non-SLE glomerular recipients (HR 1.24 CI 1.07-1.44) and non-glomerular recipients (HR 1.42 CI 1.20-1.70). SLE was associated with higher graft failure compared with non-SLE glomerular (HR 1.42 CI 1.20-1.69) and non-glomerular disease (HR 1.67 CI 1.22-2.28). SLE had a higher risk of acute rejection at 1 year compared with non-glomerular disease (HR 1.39 CI 1.03-1.88). There was a decreased risk of delayed graft function compared with non-SLE glomerular disease (HR 0.54, CI 0.36-0.82). There were no significant associations between dialysis time and transplant outcomes in the SLE group. Conclusion: SLE in children and adolescents is associated with worse patient and graft survival compared with non-SLE diagnoses. Outcomes in children and adolescents with SLE are not associated with dialysis time. Further studies are needed to assess implications of potential earlier transplantation and shorter time on dialysis prior to transplantation.

“…While specific data regarding the benefits of exercise in pediatric transplant recipients are scant, there are multiple studies linking obesity (defined as body mass index ≥95th percentile for age and sex) to inferior pediatric transplant outcomes. In recent years, obesity has been linked to increased risk for hypertension, delayed graft function, acute rejection, loss of kidney function, allograft failure, and cardiovascular mortality 80‐82 …”

Section: Hypertensionmentioning

confidence: 99%

Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia

Charnaya

Seifert

2020

Despite correction of underlying solid organ failure by transplantation, pediatric transplant recipients still have increased mortality rates compared to the general pediatric population, in part due to increased cardiovascular risk. In particular, pediatric kidney and non‐kidney transplant recipients with chronic kidney disease have significant cardiovascular risk that worsens with declining kidney function. Biomarkers associated with future cardiovascular risk such as casual and ambulatory hypertension, dyslipidemia, vascular stiffness and calcification, and left ventricular hypertrophy can be detected throughout the post‐transplant period and in patients with stable kidney function. Among these, hypertension and dyslipidemia are two potentially modifiable cardiovascular risk factors that are highly prevalent in kidney and non‐kidney pediatric transplant recipients. Standardized approaches to appropriate BP measurement and lipid monitoring are needed to detect and address these risk factors in a timely fashion. To achieve sustained improvement in cardiovascular health, clinicians should partner with patients and their caregivers to address these and other risk factors with a combined approach that integrates pharmacologic with non‐pharmacologic approaches. This review outlines the scope and impact of hypertension and dyslipidemia in pediatric transplant recipients, with a particular focus on pediatric kidney transplantation given the high burden of chronic kidney disease‐associated cardiovascular risk. We also review the current published guidelines for monitoring and managing abnormalities in blood pressure and lipids, highlighting the important role of therapeutic lifestyle changes in concert with antihypertensive and lipid‐lowering medications.