1
|
Evaluation of pediatric renal transplant recipients admitted to the intensive care unit: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background/Aim: The best course of treatment for children with end-stage kidney disease (ESKD) is renal transplantation (RT), but some pediatric RT recipients are admitted to an intensive care unit (ICU) post-transplant. In the early and late post-operative phases, clinical data about pediatric RT recipients who are admitted to ICU are available. In this study, we aimed to evaluate demographic features, main reasons, and outcomes of pediatric RT patients admitted to the ICU during the early and late post-operative phases.
Methods: This study was a cohort study. We analyzed the medical records of pediatric RT recipients (<18 years of age) who were admitted to the ICU between May 30, 2011, and October 16, 2021, at our center, retrospectively. Patients ≥18 years of age and those without available data were excluded. We obtained the following data from ICU follow-up records and hospital medical records. The median (minimum-maximum) for continuous variables, frequencies, and percentages for categorical variables were used. The Chi-square test was used to compare categorical variables. We created graphs using percentages and frequencies to summarize the results.
Results: Nineteen (16.5%) of the 115 pediatric patients who underwent RT were admitted to the ICU during the study period. Thirteen patients (68.4%) were male, and the mean age was 10.2 (4.9) years. Hypertension (21.2%) was the most common comorbidity. Eighteen (94.7%) received transplants from living donors. Cystic-hereditary-congenital disorders (42.1%, n=8) and congenital anomalies of the kidney and urinary tract (26.3%, n=5) were among the etiologies of ESKD. Ten patients (52.6%) were admitted to the ICU >6 months after transplantation. Epileptic seizure (n=6, 31.6%), respiratory failure (n=4, 21.1%), and cardiac diseases (n=2, 10.5%) were among the main reasons for ICU admission. During ICU follow-up, invasive mechanical ventilation was needed for five patients (26.3%), and renal replacement treatment was needed for four patients (21.1%). The mean length of ICU was 12.4 (28.5), and the mean hospital stay was 25.8 (29.4) days. The ICU and hospital survival rates were 78.9% and 97%, respectively, while 3.5% was the hospital mortality rate. Hemorrhagic cerebrovascular disease, acute hepatic failure, and cardiogenic shock secondary to pericardiocentesis were the causes of death in the ICU.
Conclusion: Patients mostly had ICU admissions because of epileptic seizures and acute respiratory failure. A multidisciplinary approach involving pediatric nephrologists, transplant surgeons, and an intensive care team successfully manages pediatric RT recipients admitted to the intensive care unit.
Collapse
|
2
|
Rahimzadeh N, Otukesh H, Seirafianpour F, Hoseini R. Long-Term Outcome of Kidney Transplant Among Iranian Children: A Systematic Review and Meta-Analysis. EXP CLIN TRANSPLANT 2021; 20:895-900. [PMID: 33928879 DOI: 10.6002/ect.2020.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES End-stage kidney disease has dramatic health effects and life consequences in children. Presently, kidney transplant has been globally accepted as a treatment of choice for end-stage kidney disease in both children and adults, leading to better quality of life and longer patient survival. Because of lack of comprehensive information on the outcome of kidney transplant among children in Iran, we aimed to present a proper vision of pediatric kidney transplant in Iran by systematically reviewing the current literature. MATERIALS AND METHODS Major databases were searched, including Medline, Web of Knowledge, Google Scholar, Scopus, Cochrane, and the Iranian Scientific Information Database for all eligible studies in accordance with specific keywords. The inclusion criteria for the retrieved studies were determination of graft survival, patient survival, and reasons for graft failure. The exclusion criteria were as follows: (1) a lack of clear results; (2) non-English or non-Persian language format; (3) lack of access to the full-text manuscripts; and (4) case reports, case series, and review papers. A total of 115 studies were initially assessed based on the keywords; of these, 8 met inclusion criteria and were considered for final analysis; these were published between 2005 and 2017. RESULTS According to our results, 1-year graft survival rates were overall 89.7%, and 5-year graft survival rates were 65.4%. The 1-year patient survival rates were estimated to be 97.1%, and 5-year patient survival rates were estimated to be 89.8%. Acute rejection, dialysis status before transplant, and inappropriate immunosuppression were the main risk factors. CONCLUSIONS Our systematic review and meta-analysis indicated a high success rate of childhood kidney transplant in Iran according to long-term graft and patient survival rates.
Collapse
Affiliation(s)
- Nahid Rahimzadeh
- From the Department of Pediatric Nephrology, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
3
|
Cornwell LB, Ingulli EG, Mason MD, Ewing E, Riddell JV. Renal Transplants Due to Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Have Better Graft Survival Than Non-CAKUT Controls: Analysis of Over 10,000 Patients. Urology 2021; 154:255-262. [PMID: 33454356 DOI: 10.1016/j.urology.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether graft survival for patients with congenital anomalies of the kidney and urinary tract (CAKUT) is impaired compared to non-CAKUT counterparts. METHODS The United States Renal Data System (USRDS) is a national data system that has collected information about end stage renal disease (ESRD) and renal transplantation since 1995. We identified 10,635 first-time renal transplant patients with ESRD attributed to a CAKUT diagnosis transplanted between 1995 and 2018, with follow-up of 7.9 ± 5.8 years. We matched 1:1 with non-CAKUT transplant recipients, using age at transplant, sex, race, year of transplant, and donor-type. We compared renal transplant death-censored graft survival between CAKUT vs non-CAKUT controls, with further stratification for age at transplant and lower urinary tract malformations (LUTM) vs upper urinary tract malformations (UUTM). RESULTS Graft survival was better in CAKUT patients with a 5-year survival of 83.3% vs 79.3% (P< .001), and CAKUT status infers a hazard ratio of 0.878 for graft failure on multivariable analysis with Cox regression. Favorability of CAKUT status persisted when stratifying for both pediatric (80.3 vs 77.6% P< .001) and adult (84.5 vs 81.4% P< .001) age groups. Looking within the CAKUT population: comparison of LUTM to UUTM yielded no difference, implying that LUTM is not a risk factor for graft failure. Examining pediatric LUTM alone, graft survival was not better than matched non-CAKUT counterparts with 5-year graft survival of 69%-75% for LUTM adolescents. CONCLUSION Renal transplant graft survival is better overall in CAKUT patients as opposed to non-CAKUT counterparts. Pediatric LUTM patients have similar graft survival to controls.
Collapse
Affiliation(s)
- Laura B Cornwell
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY; Rady Children's Hospital San Diego, San Diego, CA.
| | | | - Matthew D Mason
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Emily Ewing
- Rady Children's Hospital San Diego, San Diego, CA
| | | |
Collapse
|
4
|
Fadel FI, Bazaraa HM, Badawy H, Morsi HA, Saadi G, Abdel Mawla MA, Salem AM, Abd Alazem EA, Helmy R, Fathallah MG, Ramadan Y, Fahmy YA, Sayed S, Eryan EF, Atia FM, ElGhonimy M, Shoukry AI, Shouman AM, Ghonima W, Salah Eldin M, Soaida SM, Ismail W, Salah DM. Pediatric kidney transplantation in Egypt: Results of 10-year single-center experience. Pediatr Transplant 2020; 24:e13724. [PMID: 32388917 DOI: 10.1111/petr.13724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/01/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Pediatric kidney transplantation is a multidisciplinary therapy that needs special consideration and experience. In this study, we aimed to present CUCH experience; over a 10-year period, as a specialized center of kidney transplantation in children. We studied 148 transplantations performed at a single center from 2009 to 2018. Pretransplant and follow-up data were collected and graft/patient survival rates were evaluated. A total of 48 patients developed at least one rejection episode during 688 patient-years of follow-up. Infections, recurrence of original disease, and malignancy were the most important encountered medical complications (20%, 2%, and 1.4%, respectively). One-year patient survival was 94.1%, while graft and patient survival was 91.9%. Graft/patient survival at 5, 7, and 9 years was 90%, 77%, and 58%, respectively. Infections were the main cause (69%) of mortality. Death with a functioning graft and CR were the main causes of graft loss (48% and 33%, respectively). Pediatric kidney transplantation in Egypt is still a challenging yet successful experience. Rejections and infections are the most frequent complications. Short-term outcomes surpass long-term ones and graft survival rates are similar to the international standard.
Collapse
Affiliation(s)
- Fatina I Fadel
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Hafez M Bazaraa
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Hesham Badawy
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Saadi
- Department of Internal Medicine, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Amr Mohamed Salem
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | | | - Rasha Helmy
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Mohamed Gamal Fathallah
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Yasmin Ramadan
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Yosra Aboelnaga Fahmy
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Shaimaa Sayed
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Eman Fathy Eryan
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Fatma Mohammad Atia
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| | - Mohamed ElGhonimy
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Waleed Ghonima
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Salah Eldin
- Department of Urology, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif M Soaida
- Department of Anesthesia, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wesam Ismail
- Department of Pathology, Beni Suef University, Beni Suef, Egypt
| | - Doaa M Salah
- Department of Pediatrics, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt
| |
Collapse
|
8
|
Medication beliefs and perceived barriers in adolescent renal transplant patients and their parents. Pediatr Nephrol 2011; 26:953-9. [PMID: 21365191 DOI: 10.1007/s00467-011-1805-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
Understanding patient beliefs about medications and perceived barriers is important for optimal medical management. Differentiating adolescent views from parents' perceptions would enhance care by increasing communication about regimens and reducing obstacles. This study explored beliefs about medications and perceived barriers among 40 adolescent kidney transplant patients and their parents. Younger adolescents reported greater concern about medication harmfulness (t(38) = 2.190, p < 0.05) and more barriers, particularly for practical problems including forgetfulness, organization, and coordination (t(38) = 2.049, p < 0.05). Fathers with a lower education reported their children having greater challenges with medications due to taste and size (t(37) = 2.933, p < 0.01). Families with incomes in the low and high levels expressed that their children need more medication reminders (F (2, 35) = 7.815, p < 0.005), and adolescents from lower-income families perceived medication to be more harmful (F (2, 36) = 3.815, p < 0.05). Adolescents expressed challenges with practical aspects of medication taking, whereas parents were more focused on medications being necessary for their health. Adolescent renal patients experience challenges to medication management that may differ from their parents, findings that can help tailor interventions to improve medication management.
Collapse
|