Pediatric kidney transplantation: a historical review

Abstract

Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation (vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.

Pediatric kidney transplantation in Nepal

“…First successful kidney transplantation in man was possible in December 23, 1954 . While centers in the west have been practicing pediatric transplantation since 1960s, the exact time of initiation of pediatric transplantation in a developing country is unavailable . Much progress has been achieved in the field of organ transplantation till date.…”

Use of public health service increased risk kidneys in pediatric renal transplant recipients

“…Pediatric priority was categorized as pre‐Share 35, Share 35, and KAS. In 2005, Share 35 preferentially allocated organs from deceased donors under 35 years of age to pediatric patients . In 2014, KAS transitioned to priority from donors with a KDPI ≤ 35% .…”

“…Recipients without pediatric priority, referred to henceforth as "adults" or "adult recipients," were considered only for the initial analysis comparing utilization between adult and pediatric recipients. 13 In 2014, KAS transitioned to priority from donors with a KDPI ≤ 35%. 5 Finally, the onset of the American opioid epidemic was defined as January 1,…”

Scientometrics: Judging the impact of published articles in the field of pediatric kidney transplantation

“…10 In contrast, earlier single center publications on steroid avoidance, 11,12 using historical controls, were ranked very highly at #s 8 and 9 on this list-an indication of a positive result publication bias in the list, since the randomized trial only showed equivalence between the two arms, and did not affirm superiority of many metrics of steroid avoidance that were shown in the single center studies. Based on data from the journal websites, from Google Scholar and Web of Science in 2019, many newer papers 13,14 now may have greater than 45 citations of the 200th paper in the…”