Pediatric Kidney Transplantation: Experience of a Center Over 4 Decades

Cordinhã, Carolina; Rodrigues, Luís; Carmo, Carmén do; Gomes, Clara; Macário, Fernando; Correia, António Jorge; Alves, Rui; Figueiredo, Arnaldo

doi:10.1016/j.transproceed.2019.05.007

Cited by 9 publications

(5 citation statements)

References 13 publications

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“…Despite advances in surgical techniques and peri‐ and postoperative treatment, the field of pediatric KTx remains challenging, not least due to an ongoing lack of size‐matched grafts, anatomical peculiarities, smaller transplant numbers, and thus less clinical data 4,8,10 …”

Section: Discussionmentioning

confidence: 99%

“…Previous publications emphasized increased rates of urological and vascular complications after pediatric KTx, especially in case of pediatric donors; however, recent data on incidence and risk factors as well as the effects of such complications in larger patient series are scarce since most studies focus on long‐term outcomes and immunological issues 9,10,15,16 …”

Section: Discussionmentioning

confidence: 99%

“…Although graft and patient outcomes have significantly improved over the last decades, KTx in pediatric patients remains challenging due to smaller sized recipients, accompanying donor‐recipient mismatches and congenital anomalies, and is associated with increased postoperative complications 7‐10 . Accordingly, a high level of surgical expertise and an optimized donor selection is imperative 10 …”

Section: Introductionmentioning

confidence: 99%

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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

Pediatric Transplantation

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Pediatric Transplantation

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“…But even for an adolescent or young adult, this means $50 years of graft function. The vast majority of pediatric patients will require more than one transplant (3). To maintain graft function, pediatric recipients must negotiate numerous challenges.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Care of the Pediatric Kidney Transplant Recipient

Fernández

Foster

2022

CJASN

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Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize transition to adult-oriented transplant care and long-term outcomes.

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“…Complete data on the primary outcome was available in all cases. The study cohort reflects a typical pediatric kidney transplant population 2,5,21 that is predominately male sex ( n = 35, 60%) and young adolescent age at transplant (mean 11.7 ± 5.7 years) (Table 1). There was a higher percentage of Black patients (52%) at UAB compared to BCCH (7%).…”

Section: Resultsmentioning

confidence: 99%

Follow‐up biopsies identify high rates of persistent rejection in pediatric kidney transplant recipients after treatment of T cell‐mediated rejection

Landsberg,

Raza,

Seifert

et al. 2023

Pediatric Transplantation

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BackgroundIncomplete resolution of T cell‐mediated rejection (TCMR) after treatment may not be detected with serum creatinine monitoring and is associated with donor‐specific antibodies and chronic rejection. We evaluate the utility of follow‐up biopsies (FUB) to identify and characterize rates of persistent TCMR after treatment in pediatric kidney transplant patients.MethodsPatients from two pediatric transplant centers performing standard of care FUB at 1.5–2 months after treatment for TCMR were included. FUB were evaluated for extent of rejection resolution (complete vs. incomplete) and grade. Clinical data at time of FUB and later were reported, where available.ResultsFifty‐eight patients underwent FUB, at mean of 1.7 months (SD 0.7) post‐index biopsy. Rejection grade on index biopsy was Banff borderline (≥i1t1 and <i2t2) in 59% and Banff ≥1A (≥i2t2) in 41%. Acute rejection was persistent in 32 (55%) of FUB. Borderline rejection had higher rates of complete resolution of rejection compared to grade ≥1A (53% vs. 33%, p = .033). Incomplete resolution of rejection on FUB was re‐treated in 25 (78%) of cases. Change in eGFR from index to FUB did not differ between those with complete and incomplete resolution (5.7 ± 32.2 vs. 13.1 ± 51.3, p = .28) and was not a sensitive marker of identifying persistent rejection.ConclusionsFUB were effective at detecting persistent rejection, which was common among pediatric transplant patients after standard TCMR treatment. Until more effective rejection treatments or sensitive biomarkers are available, FUB may be effectively utilized to identify patients with ongoing rejection who would benefit from further treatment.

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Pediatric Kidney Transplantation: Experience of a Center Over 4 Decades

Cited by 9 publications

References 13 publications

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

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

Long-Term Care of the Pediatric Kidney Transplant Recipient

Follow‐up biopsies identify high rates of persistent rejection in pediatric kidney transplant recipients after treatment of T cell‐mediated rejection

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