Pediatric renal transplantation in a South African teaching hospital: A 20‐year perspective

Abstract

Pediatric renal transplantation in Johannesburg can be accomplished with low complication rates, but medium and long-term graft survival is poor when compared with contemporary results achieved in developed countries. The difficulties of undertaking such complex, multidisciplinary interventions in a developing nation are daunting, but we believe that renal transplantation should still be the treatment of choice for all children with ESRF. The poorer outcomes in black recipients can be addressed by increasing education in our communities and expanding the pool of appropriate donors. Better institutional support would allow for improved long-term patient care.

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

“…Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) reviewed 282 paediatric transplants from 1984 to 2003. [13] Ten-year recipient and graft survival rates were 68% and 23%, respectively. Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town reviewed 89 transplants from 1995 to 2005 and found the 7-year graft survival rate to be 72%.…”

Long-term outcome after renal transplantation in childhood

“…Available resources [7, 14] affect patient selection, follow-up and drug regimens. Community attitudes influence decisions regarding treatment of high-risk patients such as neonates and children with handicaps [15].…”

An overview of disparities and interventions in pediatric kidney transplantation worldwide

“…[3] Further, there exist pervasive racial and ethnic disparities in kidney transplantation in both the adult and pediatric setting. [4–7] While much of the research examining this issue has been conducted in the United States, similar disparities have been identified in Australia[8], Belgium[7], Canada[9] the Netherlands[7], South Africa[10], and the United Kingdom[11] among others, indicating the global nature of this issue. Although it is important to note that some of these disparities may be the result of factors that are beyond the control of the medical system (e.g., co-morbidities and hereditary diseases that are associated with certain ethnic groups), [12, 13] studies have repeatedly demonstrated that differences in medical factors alone are not sufficient to explain the disparities in transplantation in their entirety.…”

“…There are clear disparities in post-transplant outcomes as well[7, 10, 17, 41]. A 2007 analysis of the over 6287 pediatric patients who had been registered in the NAPRTCS database demonstrated that 5-year graft survival rates for AA children were significantly lower than for white children (65.6% versus 83.1%).…”

“…[17] This increased risk for graft failure persisted in AA children despite correcting for demographic and clinical factors including age, etiology of ESRD and HLA matching Data from a single center in South Africa examining pediatric kidney transplant outcomes between 1985 and 2005 demonstrated that black children had a median allograft survival rate of 4.22 years, as opposed to 6.29 years for their white counterparts. [10] Disparities in the rates of acute rejection in the post-transplant setting have been described in the Netherlands and Belgium. [7] In addition to being at increased risk for poor graft outcomes, other studies have demonstrated AA pediatric patients are at increased risk of other health disparities in the post-transplant setting, including increased rates of hypertension.…”