Pre‐emptive renal transplantation in children

Harada, Hiroshi; Seki, Toshimori; Nonomura, Katsuya; Chikaraishi, Tatsuya; Takeuchi, Ichiro; Morita, Ken; Usuki, Tomoaki; Watarai, Yoshihiko; Terabe, Masaki; Hirano, Tetsuo; Koyanagi, Tomohiko

doi:10.1046/j.1442-2042.2001.00285.x

Cited by 19 publications

(21 citation statements)

References 13 publications

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“…In terms of preemptive RTx, 25% of patients in G1 and G2 and 17% in G3 received a preemptive graft; these percentages are higher than those reported by Cransberg et al in Europe (ie, 14%, with 20% of DD) . Even though the effect of preemptive RTx on graft survival differs between studies, we were unable to demonstrate any benefit of preemptive RTx in the present series.…”

Section: Discussioncontrasting

confidence: 80%

Renal transplantation in children under 3 years of age: Experience from a single‐center study

Loiseau

Bacchetta

Klich

et al. 2018

Pediatric Transplantation

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RTx remains challenging in children under 3 years of age. This single-center study reviewed the medical records of children <3 years transplanted since 1987 (N = 32, Group 1). They were matched for donor type and RTx period with children aged 3-13 years (N = 32, Group 2) and 13-18 years (N = 32, Group 3). There were no between-group significant differences regarding distributions of gender, primary renal disease, proportion of dialysis before RTx, and growth (SDS). Compared to Groups 2 and 3, Group 1 had more peritoneal dialyses (P < .001), more EBV mismatches (P = .04), and longer warm ischemia times (P < .001). The risk of graft loss was not significantly different among age groups (hazard ratio, 2.4 in Group 2 and 2.0 in Group 3 vs Group 1; P = .2). Death occurred in four patients (3 in Group 1 and 1 in Group 2) and graft loss occurred in 28 patients, mainly due to chronic allograft nephropathy. In recipients <3 years of age, the outcomes of RTx are close to those obtained in older pediatric age groups. Thus, young patients may be transplanted in experienced multidisciplinary teams without additional risks provided that particular attention is paid to donor selection and prevention/early diagnosis of comorbidities and complications.

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Section: Discussioncontrasting

confidence: 80%

Renal transplantation in children under 3 years of age: Experience from a single‐center study

Loiseau

Bacchetta

Klich

et al. 2018

Pediatric Transplantation

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“…More than half of the participating patients, who were at that time on dialysis, had previously undergone transplantation and had experienced graft rejection. Pre-emptive transplantation results in improved growth and better psychosocial development [32,33], although we did not find better scores of HRQOL in this group of transplant patients. The use of a specific HRQOL instrument would be better suited to detect subtle changes and specific symptoms that modify HRQOL.…”

Section: Discussionmentioning

confidence: 46%

Quality of life of adolescents with end-stage renal disease and kidney transplant

Riaño‐Galán

Rajmil

et al. 2009

Pediatr Nephrol

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The health-related quality of life (HRQOL) of adolescents with end-stage renal disease (ESRD) is an important marker of disease burden. Our aims were to investigate HRQOL in a group of children and adolescents with ESRD and to compare them with the reference population norms. Ours was a cross-sectional study of 81 patients aged 10 years to 21 years with ESRD (68 with kidney transplants and 13 on dialysis) at five Spanish paediatric nephrology centres. HRQOL was investigated with the Spanish version of the child health and illness profile, adolescent edition (CHIP-AE). Clinical variables such as underlying diagnosis, number of rejection episodes, pre-emptive transplantation, anaemia and height were also analysed. No differences were found between patients with kidney transplants and their healthy peers in any domain or sub-domain of CHIP-AE. The group on dialysis scored lower than healthy controls and patients with transplants for satisfaction with health. Discomfort was higher in patients with transplants who had suffered one rejection episode. Physical discomfort was increased in anaemic patients with transplants. Short patients scored less in the satisfaction domain, with lower self-esteem and lower satisfaction with health. Adolescents with kidney transplants had better satisfaction with health than the group on dialysis, which matched the level of a healthy population. Further long-term prospective research is warranted.

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“…9–14 However, the benefits of completely circumventing dialysis for children with ESRD have not been clearly demonstrated. Several studies have demonstrated no differences in patient or graft survival between children receiving preemptive vs. non-preemptive transplant 15–21 and there is some evidence to suggest discrepancies in the graft survival benefits of preemptive transplants by donor source. 22–24 Importantly, the majority of these studies have been limited by small sample size and few events.…”

Section: Introductionmentioning

confidence: 99%

“…22–24 Importantly, the majority of these studies have been limited by small sample size and few events. 15–24 We hypothesized that given a large, national sample of children with ESRD followed over a decade, we would observe significant patient and graft survival benefits of preemptive vs. non-preemptive kidney transplantation and would be able to discern whether any differences exist across donor source.…”

Section: Introductionmentioning

confidence: 99%

Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease

Amaral

Sayed

Kutner

et al. 2016

Kidney International

136

123

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Kidney transplantation is the preferred treatment for pediatric end stage renal disease (ESRD). Preemptive transplantation avoids the increased morbidity and mortality of dialysis. Yet, prior studies have not demonstrated significant graft or patient survival benefits for children transplanted preemptively versus non-preemptively. These previous studies were limited by small samples sizes and low rates of adverse events. Here, we compared graft failure and mortality rates, using Kaplan-Meier methods and Cox regression, among a large, national cohort of children with ESRD receiving preemptive versus non-preemptive kidney transplant between 2000 and 2012. Among 7,527 pediatric kidney transplant recipients in the United States Renal Data System, 1668 were transplanted preemptively. Over a median 4.8 years follow-up, 1314 experienced graft failure and over median 5.2 years of follow-up, 334 died. Dialysis exposure versus preemptive transplant conferred higher risk of graft failure (hazard ratio 1.32; 95% confidence interval: 1.10–1.56) and higher risk of death (hazard ratio 1.69; 95% confidence interval: 1.22–2.33) in multivariable analysis. Compared with children transplanted preemptively, children on dialysis for more than one year had 52% higher risk of graft failure and those on dialysis more than 18 months had 89% higher risk of death, regardless of donor source. Thus, preemptive transplantation is associated with substantial benefits in allograft and patient survival among children with ESRD, particularly when compared with children who receive dialysis for over one year. These findings support policies to promote early access to transplant and avoidance of dialysis for children with ESRD whenever feasible.

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Pre‐emptive renal transplantation in children

Cited by 19 publications

References 13 publications

Renal transplantation in children under 3 years of age: Experience from a single‐center study

Renal transplantation in children under 3 years of age: Experience from a single‐center study

Quality of life of adolescents with end-stage renal disease and kidney transplant

Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease

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