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

Loiseau, Yann; Bacchetta, Justine; Klich, Amna; Ranchin, Bruno; Demède, Delphine; Laurent, Audrey; Baudin, Florent; Garaix, Florentine; Roy, Pascal; Cochat, Pierre

doi:10.1111/petr.13116

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…The use of our protocol has resulted in both patient and graft survival that compare favorably with recently published studies . In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%‐10% reported in prior studies .…”

Section: Discussionsupporting

confidence: 86%

“…21,22 The use of our protocol has resulted in both patient and graft survival that compare favorably with recently published studies. 10,[23][24][25][26] In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%-10% reported in prior studies. 10,23 Due to multiple factors, ranging from cold ischemia time, hypotension, and donor age, DGF is a significant risk factor for the development of both acute rejection and subsequent graft loss.…”

Section: Discussioncontrasting

confidence: 43%

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Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Lee

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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Kidney transplantation remains the treatment of choice for children with ESRD. Optimal perioperative management is critical in small recipients of ASK to assure adequate graft perfusion. We present a single‐center experience outlining management for patients weighing <20 kg who underwent primary renal transplantation with ASKs between 2007 and 2016. Sixty‐three patients met study criteria and underwent 34 living‐related, six living‐unrelated, and 23 deceased donor kidney transplants. Median age and weight at transplant were 25 months (IQR 18‐37 months; range 11 months‐6 years) and 11.0 kg (IQR 9.2‐14.5 kg; range 7.1‐19.5 kg). Eighty‐nine percent of patients required vasoactive agents intra‐operatively, with twenty patients requiring prolonged vasoactive agents post‐operatively. Intra‐operatively, patients received 51.9 mL/kg of crystalloid, 27.3 mL/kg of 5% albumin, and 13.6 mL/kg of packed red blood cells. Most (93.7%) patients were extubated on POD#0. Weights peaked on post‐operative days three through five. Over a median follow‐up of 49 months (IQR 31‐86 months; range 0‐130 months), four grafts were lost, two due to thrombosis and two secondary to chronic rejection. There was one patient death six months post‐transplant due to causes unrelated to transplantation. Graft survival at 1, 5, and 10 years was 98.4%, 96.6%, and 84.2%, respectively. Of surviving allografts, the median 1, 5, and 10 years post‐transplant eGFR was 122.9, 90.0, and 59.2 mL/min/1.73 m2 as determined by the 2009 Schwartz formula. Renal transplantation in small children using ASKs requires meticulous perioperative management including adequate fluid resuscitation and judicious use of pressors to assure adequate graft perfusion. The use of ASKs from living or deceased donors results in satisfactory short and long‐term outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 43%

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Lee

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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“…All kidney transplants were coming from deceased donors. Two patients lost their graft because of venous graft thrombosis, as previously reported [19]. Long-term outcomes are summarised in Table 4.…”

Section: Long-term Outcomesmentioning

confidence: 72%

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Dachy

Bacchetta

Sellier‐Leclerc

et al. 2020

Néphrologie & Thérapeutique

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Background. -Little data are available for infants who started renal replacement therapy before 6 months of age. Because of extra-renal comorbidities and uncertain outcomes, whether renal replacement therapy in neonates is justified remains debatable. Methods. -We performed a retrospective analysis of all patients who began chronic peritoneal dialysis below 6 months between 2007 and 2017 in two tertiary centres. Results are presented as median (min;max). Results. -Seventeen patients (10 boys) were included (8 prenatal diagnoses, 6 premies), with the following diagnoses: congenital anomalies of kidney and urinary tract (n = 9), oxalosis (n = 5), congenital nephrotic syndrome (n = 2) and renal vein thrombosis (n = 1). Five patients had associated comorbidities. At peritoneal dialysis initiation, age was 2.6 (0.1;5.9) months, height-standard deviation score (SDS) À1.3 (À5.7;1.6) and weight-SDS À1.4 (À3.6;0.6). Peritoneal dialysis duration was 12 (2;32) months, and at peritoneal dialysis discontinuation height-SDS was À1.0 (À4.3;0.7) weight-SDS À0.7 (À3.2;0.2), parathyroid hormone 123 (44;1540) ng/L, and hemoglobin 110 (73;174) g/L. During the first 6 months of peritoneal dialysis, the median time of hospitalisation stay was 69 (15;182) days. Ten patients presented a total of 27 peritonitis episodes. Reasons for peritoneal dialysis discontinuation were switch to hemodialysis (n = 6), transplantation (n = 6), recovery of renal function (n = 2) and death (n = 1). After a follow-up of 4.3 (1.7;10.3) years, 12 patients were transplanted, 2 patients were still on peritoneal dialysis, 2 patients were dialysis free with severe chronic kidney disease and 1 patient had died. Seven patients displayed neurodevelopmental delay, of whom five needed special schooling. Conclusion. -We confirm that most infants starting peritoneal dialysis before 6 months of age will be successfully transplanted and will have a favourable growth outcome. Their quality of life will be impacted by recurrent hospitalisations and neurodevelopmental delay is frequent.

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“…Prolonged ileus may lead to increased length of stay after transplant, and our cohort had a median length of stay of 26 days. Several recent studies of pediatric renal transplant have reported LOS as ranging from 13 to 24 days 14,28,29 . Of note, 86% of patients in the Lee et al study reporting LOS of 13 days received intraperitoneal transplant, while patients in the Weitz et al study at the upper end of the spectrum (24 days) received primarily retroperitoneal transplants 14,29 .…”

Section: Discussionmentioning

confidence: 99%

Good outcomes after pediatric intraperitoneal kidney transplant

Gerzina

Brewer

Guhan

et al. 2022

Pediatric Transplantation

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Background: Kidney transplantation in small children is technically challenging.Consideration of whether to use intraperitoneal versus extraperitoneal placement of the graft depends on patient size, clinical history, anatomy, and surgical preference.We report a large single-center experience of intraperitoneal kidney transplantation and their outcomes. Methods:We conducted a retrospective review of pediatric patients who underwent kidney transplantation from April 2011 to March 2018 at a single large volume center.We identified those with intraperitoneal placement and assessed their outcomes, including graft and patient survival, rejection episodes, and surgical or non-surgical complications.Results: Forty-six of 168 pediatric kidney transplants (27%) were placed intraperitoneally in children mean age 5.5 ± 2.3 years (range 1.6-10 years) with median body weight 18.2 ± 5 kg (range 11.4-28.6 kg) during the study period. Two patients (4%) had vascular complications; 10 (22%) had urologic complications requiring intervention; all retained graft function. Thirteen patients (28%) had prolonged post-operative ileus. Eight (17%) patients had rejection episodes ≤6 months post-transplant. Only one case resulted in graft loss and was associated with recurrent focal segmental glomerular sclerosis (FSGS). Two patients (4%) had chronic rejection and subsequent graft loss by 5-year follow-up. At 7-year follow-up, graft survival was 93% and patient survival was 98%. Conclusions:The intraperitoneal approach offers access to the great vessels, which allows greater inflow and outflow and more abdominal capacity for an adult donor kidney, which is beneficial in very small patients. Risk of graft failure and surgical Pediatric patients constitute <2% of the kidney transplant recipients in the United States and offer unique surgical challenges for transplant. 1 Historically, matching donor size and age for pediatric patients led to significant graft loss, largely a result of vessel thromboses when small, pediatric kidneys were implanted in small, pediatric recipients. 2 Kidney transplants from larger and older donors are now routinely used in small pediatric patients, necessitating renal artery and vein anastomoses to larger recipient blood vessels, usually the aorta and inferior vena cava (IVC) depending on the recipient size, anatomical limitations and surgeon's preference. 3 In the current era, patient and graft survival for small pediatric patients weighing <30 kg is similar to adult outcomes, though smaller patients may still be at increased risk for vascular complications. [4][5][6][7][8] Several studies indicate that vascular complications are more common in pediatric than adult transplant recipients 7 and may be the most frequent complication in pediatric patients, with one study reporting vascular complication rates as high as 13.8%. 7,9 Additionally, renal vein thrombosis has been a major cause of firstyear graft failure in pediatric patients with increased risk in those <4 years old and those with lower body weight. 10,11 ...

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

Cited by 7 publications

References 34 publications

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Good outcomes after pediatric intraperitoneal kidney transplant

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