Strategy to Enable and Accelerate Kidney Transplant in Small Children and Results of the First 130 Transplants in Children ≤15 kg in a Single Center

Abstract

Background. Proper care of young children in need of kidney transplant (KT) requires many skilled professionals and an expensive hospital structure. Small children have lesser access to KT. Methods. We describe a strategy performed in Brazil to enable and accelerate KT in children ≤15 kg based on the establishment of one specialized transplant center, focused on small children, and cooperating with distant centers throughout the country. Actions on 3 fronts were implemented: (a) providing excellent medical assistance, (b) coordinating educational activities to disseminate expertise and establish a professional network, and (c) fostering research to promote scientific knowledge. We presented the number and outcomes of small children KT as a result of this strategy. Results. Three hundred forty-six pediatric KTs were performed in the specialized center from 2009 to 2017, being 130 in children ≤15 kg (38%, being 41 children ≤10 kg) and 216 in >15 kg (62%). Patient survival after 1 and 5 years of the transplant was 97% and 95% in the “small children” group, whereas, in the “heavier children” group, it was 99% and 96% (P = 0.923). Regarding graft survival, we observed in the “small children” group, 91% and 87%, whereas in the “heavier children” group, 94% and 87% (P = 0.873). These results are comparable to the literature data. Groups were similar in the incidence of reoperation, vascular thrombosis, posttransplant lymphoproliferative disease, and estimated glomerular filtration rate. Conclusions. The strategy allowed an improvement in the number of KT in small children with excellent results. We believe this experience may be useful in other locations.

Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review

“…Finally, a total of 23 studies were included in this systematic review (Fig. 1) [9][10][11]12,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Kidney Transplantation in ≤15 kg Children: Outcomes and Prognostic Indicators—A Review of the Organ Procurement and Transplantation Database

“…Multisystem organ failure ± infection 5 (5) Respiratory failure (various causes) 25 ( recipients had better graft survival compared with 3 to 10-year-old patients (Table 7).…”

“…Despite these challenges, the patient and graft survival for recipients ≤15 kg has been excellent in the modern era. Multiple studies comparing kidney transplants in recipients ≤15 kg versus those >15 kg found no difference in outcomes related to patient and graft survival [5][6][7][8]. Other studies have shown that it is possible to achieve >80% graft survival up to 10 years posttransplant even in this high-risk populace [9].…”