Pediatric Transplantation in the United States, 1996–2005

Abstract

Solid organ transplantation is accepted as a standard lifesaving therapy for end-stage organ failure in children. This article reviews trends in pediatric transplantation from 1996 to 2005 using OPTN data analyzed by the Scientific Registry of Transplant Recipients. Over this period, children have contributed significantly to the donor pool, and although the number of pediatric donors has fallen from 1062 to 900, this still accounts for 12% of all deceased donors. In 2005, 2% of 89 884 candidates listed for transplantation were less than 18 years old; in 2005, 1955 children, or 7% of 28 105 recipients, received a transplant. Improvement in waiting list mortality is documented for most organs, but pretransplant mortality, especially among the youngest children, remains a concern. Posttransplant survival for both patients and allografts similarly has shown improvement throughout the period; in most cases, survival is as good as or better than that seen in adults. Examination of immunosuppressive practices shows an increasing tendency across organs toward tacrolimus-based regimens. In addition, use of induction immunotherapy in the form of anti-lymphocyte antibody preparations, especially the interleukin-2 receptor antagonists, has increased steadily. Despite documented advances in care and outcomes for children undergoing transplantation, several considerations remain that require attention as we attempt to optimize transplant management.

Pediatric Transplantation in the United States, 1997–2006

“…At the end of 2005, there were 311 pediatric intestine recipients living with functioning transplants. Previous reports have discussed in detail the high death rate for candidates awaiting intestine transplantation and how these candidates seem less well served by PELD or MELD compared to liver alone candidates (4,8 …”

Langzeitüberleben bei chronischer Niereninsuffizienz

“…Die in der betreffenden Studie untersuchte besonders problematische Gruppe der Adoleszenten sticht in einer Übersicht zum Organüberleben bei transplantierten Kindern und Jugendlichen heraus [77]. Wäh-rend das kurzfristige Organüberleben in allen untersuchten Altersgruppen vergleichbar gut ausfällt, zeigt sich in der Gruppe der Adoleszenten drei und fünf Jahre nach Transplantation ein signifikanter Anstieg der Zahl an Organverlusten [78]. Im Vergleich zu jüngeren Kindern und zu Erwachsenen ist die Prävalenz einer Non-Adhärenz bei nierentransplantierten Jugendlichen deutlich erhöht [79].…”

Pushing the boundaries: The current status of ABO-incompatible cardiac transplantation

“…[1][2][3] Infants often present in poor clinical condition and waiting list mortality is higher than in adults, 4,5 with figures of between 23% and 50% reported in some studies. 4 -6 Previously, solid-organ transplantation with blood group incompatibility between donors and recipients was contraindicated due to the risk of pre-formed isohemagglutinins causing hyperacute rejection.…”