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Anand A, Malik TH, Dunson J, McDonald MF, Christmann CR, Galvan NTN, O'Mahony C, Goss JA, Srivaths PR, Brewer ED, Rana A. Factors associated with long-term graft survival in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13999. [PMID: 33704871 DOI: 10.1111/petr.13999] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Pediatric kidney transplant recipients generally have good outcomes post-transplantation. However, the younger age and longer life span after transplantation in the pediatric population make understanding the multifactorial nature of long-term graft survival critical. This investigation analyzes factors associated with 10-year survival to identify areas for improvement in patient care. Kaplan-Meier with log-rank test and univariable and multivariable logistic regression methods were used to retrospectively analyze 7785 kidney transplant recipients under the age of 18 years from January 1, 1998, until March 9, 2008, using United Network for Organ Sharing (UNOS) data. Our end-point was death-censored 10-year graft survival after excluding recipients whose grafts failed within one year of transplant. Recipients aged 5-18 years had lower 10-year graft survival, which worsened as age increased: 5-9 years (OR: 0.66; CI: 0.52-0.83), 10-14 years (OR: 0.43; CI: 0.33-0.55), and 15-18 years (OR: 0.34; CI: 0.26-0.44). Recipient African American ethnicity (OR: 0.67; CI: 0.58-0.78) and Hispanic donor ethnicity (OR: 0.82; CI: 0.72-0.94) had worse outcomes than other donor and recipient ethnicities, as did patients on dialysis at the time of transplant (OR: 0.82; CI: 0.73-0.91). Recipient private insurance status (OR: 1.35; CI: 1.22-1.50) was protective for 10-year graft survival. By establishing the role of age, race, and insurance status on long-term graft survival, we hope to guide clinicians in identifying patients at high risk for graft failure. This study highlights the need for increased allocation of resources and medical care to reduce the disparity in outcomes for certain patient populations.
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Affiliation(s)
- Adrish Anand
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Tahir H Malik
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Jordan Dunson
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Malcolm F McDonald
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | | | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christine O'Mahony
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Poyyapakkam R Srivaths
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Eileen D Brewer
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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2
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Marsac L, Michelet D, Sola C, Didier-Vidal A, Combet S, Blanc F, Orliaguet G, Aubineau JV, Julien-Marsollier F, Brasher C, Dahmani S. A survey of the anesthetic management of pediatric kidney transplantation in France. Pediatr Transplant 2019; 23:e13509. [PMID: 31168909 DOI: 10.1111/petr.13509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Renal transplantation is the best available therapeutic option for end-stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. MATERIAL AND METHODS The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). RESULTS Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. CONCLUSIONS The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.
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Affiliation(s)
- Lucile Marsac
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Chrystelle Sola
- Pediatric Anesthesia Unit, Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier University, Montpellier, France.,IGF, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Anne Didier-Vidal
- Department of Anesthesia and Intensive Care, Hôpital des Enfants, Groupe Hospitalier Pellegrin, Bordeaux Cedex, France
| | - Sylvie Combet
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Hopital Femme Mere Enfant, Bron, France
| | - Frederic Blanc
- Department of Anesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Timone Enfants Hospital, Aix-Marseille University, Marseille, France
| | - Gilles Orliaguet
- Department of Anesthesia and Intensive Care, Necker-Enfant Malades Hospital, Paris, France.,EA08, Pharmacologie et Évaluation des Thérapeutiques Chez L'enfant et la Femme Enceinte, Paris-Descartes and Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, Paris, France
| | | | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Childrens' Research Institute, Parkville, Victoria, Australia
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.,PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
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3
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Michelet D, Brasher C, Marsac L, Zanoun N, Assefi M, Elghoneimi A, Dauger S, Dahmani S. Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation. Paediatr Anaesth 2017; 27:927-934. [PMID: 28736994 DOI: 10.1111/pan.13201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure. The main outcome of the study was the creatinine clearance at day 1 corrected to a body surface area of 1.73 m². Analysis was performed using Classification Tree Analysis with 10-fold cross-validation. RESULTS One hundred and two patients were included. The following predictors of increased postoperative creatinine clearance at day 1 were identified: decreasing recipient weight, mean blood pressure-to-weight ratio 10 minutes after reperfusion, reduced cold ischemia duration, and increased intraoperative albumin infusion. Increased creatinine clearance was observed when mean blood pressure-to-weight ratio 10 minutes after reperfusion was ≥4.3 in patients weighing 13-21 kg and ≥2.5 in those ≥22 kg. Overall, the model explained 64% (and at cross-validation 60%) of creatinine clearance variability at day 1. CONCLUSION Intraoperative hemodynamics during kidney transplantation should be optimized in order to increase mean blood pressure according to values indicated by our analyses. Cold ischemia duration should be shortened as far as possible.
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Affiliation(s)
- Daphné Michelet
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Lucile Marsac
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Nabil Zanoun
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Mona Assefi
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France
| | - Alaa Elghoneimi
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,Department of general and urological surgery, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Stephane Dauger
- Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France.,Departement of Paediatric Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France
| | - Souhayl Dahmani
- Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, France.,DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France
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Abstract
Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation.
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Affiliation(s)
- Nicholas R Wasson
- Pediatric Transplant Anesthesia, Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 19, Chicago, IL 60611, USA.
| | - Jeremy D Deer
- Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box 19, Chicago, IL 60611-2605, USA
| | - Santhanam Suresh
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 East Chicago Avenue, Box 19, Chicago, IL 60611-2605, USA
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5
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Luijten JCHBM, Voet M, de Gier RPE, Nusmeier A, Scharbatke H, van der Vliet JA, Cornelissen EAM. Transplantation of adult living donor kidneys in small children, a single-centre initial experience. Transpl Int 2017; 30:640-642. [DOI: 10.1111/tri.12947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Josianne C. H. B. M. Luijten
- Department of Paediatric Nephrology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Vascular and Transplant Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Marieke Voet
- Department of Pediatric Anesthesiology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Robert P. E. de Gier
- Department of Pediatric Urology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Anneliese Nusmeier
- Department of Pediatric Intensive Care; Radboud University Medical Center; Nijmegen The Netherlands
| | - Horst Scharbatke
- Department of Vascular and Transplant Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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6
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Öborn H, Wettergren L, Herthelius M, Forinder U. Associations between lower urinary tract dysfunction and health-related quality of life in children with chronic kidney disease. Acta Paediatr 2016; 105:959-66. [PMID: 27127995 PMCID: PMC5089597 DOI: 10.1111/apa.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/01/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Abstract
Aim Little is known about the health‐related quality of life (HRQoL) of children with lower urinary tract dysfunction (LUTD) and chronic kidney disease (CKD). We investigated LUTD and other possible predictors of impaired HRQoL in children with conservatively treated moderate‐to‐severe CKD or with a kidney transplant. Methods All 64 children with CKD or a kidney transplant treated at Karolinska University Hospital, Stockholm, Sweden, between June 2011 and December 2012 were approached and 59 children aged 8–18 were enrolled in the study. Lower urinary tract function was evaluated with voiding history, frequency and volume chart, uroflowmetry and postvoid ultrasound measurements. Self‐reported HRQoL was assessed with validated generic instruments. Results The HRQoL of the study cohort was as good as the general paediatric population, apart from the physical and psychological well‐being dimensions, and was no different to children with other chronic conditions. Urinary incontinence, but not LUTD in general, was associated with impaired HRQoL, as was having a kidney transplant and being female in some dimensions. Conclusion LUTD was common in children with CKD or a kidney transplant but did not affect their general HRQoL. Predictors of impaired HRQoL included incontinence, having had a kidney transplant and being female.
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Affiliation(s)
- Helena Öborn
- Department of Clinical Science, Technology and Intervention Division of Pediatrics Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society Division of Nursing Karolinska Institutet Stockholm Sweden
| | - Maria Herthelius
- Department of Clinical Science, Technology and Intervention Division of Pediatrics Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Ulla Forinder
- Department of Neurobiology, Care Sciences and Society Division of Social Work Karolinska Institutet Stockholm Sweden
- Department of Health and Working Life Division of Social Work and Psychology University of Gävle Gävle Sweden
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7
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Castañeda DA, López LF, Ovalle DF, Buitrago J, Rodríguez D, Lozano E. Growth, chronic kidney disease and pediatric kidney transplantation: is it useful to use recombinant growth hormone in Colombian children with renal transplant? Transplant Proc 2014; 43:3344-9. [PMID: 22099793 DOI: 10.1016/j.transproceed.2011.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Kidney transplantation has become the best treatment for children with chronic kidney disease (CKD). In recent times, knowledge concerning the effect of CKD and kidney transplantation over the normal growth rate has increased; now it is known that 40% of children with CKD do not reach the expected height for age. Growth retardation has been associated with the type of nephropathy, metabolic and endocrine disorders that are secondary to kidney disease, immunosuppressive therapy with glucocorticoids, and suboptimal function of renal allograft. Nowadays, we know better the role of the growth hormone/insulin-like growth factor 1 axis in growth retardation we can see it in children with CKD or recipients of renal allograft. Several studies have shown that administration of recombinant growth hormone (rhGH) has a positive effect on the longitudinal growth of children and teenagers who have received a kidney transplant. On the other hand, there have been reported side effects associated with using rhGH; however, these are not statistically significant. In this article, we show a small review about growth in children with CKD and/or recipients of renal allografts the growth pattern of three children who were known by the Transplant Group of National University of Colombia, and the results obtained with the use of rhGH in one of these cases. We want to show the possibility of achieving a secure use of rhGH in children with CKD and its use as a therapeutic option for treating the growth retardation in children with kidney transplantation, and set out the need of typifying the growth pattern of Colombian children with CKD and/or who are recipients of renal allografts through multicenter studies to propose and analyze the inclusion of rhGH in the therapeutic scheme of Colombian children with these two medical conditions. rhGH could be a useful tool for treating children with CKD or kidney transplantation who have not reached the expected longitudinal growth for age. However, it is necessary to know the growth pattern standards for Colombian children with CKD or kidney transplant in Bogotá-Colombia to include the rhGH in clinical protocols for treatment of these patients.
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Affiliation(s)
- D A Castañeda
- Organ and Tissues Transplant Group, National University of Colombia, School of Medicine, Department of Surgery, Bogotá, Colombia.
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8
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Van Arendonk KJ, Boyarsky BJ, Orandi BJ, James NT, Smith JM, Colombani PM, Segev DL. National trends over 25 years in pediatric kidney transplant outcomes. Pediatrics 2014; 133:594-601. [PMID: 24616363 PMCID: PMC4530294 DOI: 10.1542/peds.2013-2775] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate changes in pediatric kidney transplant outcomes over time and potential variations in these changes between the early and late posttransplant periods and across subgroups based on recipient, donor, and transplant characteristics. METHODS Using multiple logistic regression and multivariable Cox models, graft and patient outcomes were analyzed in 17,446 pediatric kidney-only transplants performed in the United States between 1987 and 2012. RESULTS Ten-year patient and graft survival rates were 90.5% and 60.2%, respectively, after transplantation in 2001, compared with 77.6% and 46.8% after transplantation in 1987. Primary nonfunction and delayed graft function occurred in 3.3% and 5.3%, respectively, of transplants performed in 2011, compared with 15.4% and 19.7% of those performed in 1987. Adjusted for recipient, donor, and transplant characteristics, these improvements corresponded to a 5% decreased hazard of graft loss, 5% decreased hazard of death, 10% decreased odds of primary nonfunction, and 5% decreased odds of delayed graft function with each more recent year of transplantation. Graft survival improvements were lower in adolescent and female recipients, those receiving pretransplant dialysis, and those with focal segmental glomerulosclerosis. Patient survival improvements were higher in those with elevated peak panel reactive antibody. Both patient and graft survival improvements were most pronounced in the first posttransplant year. CONCLUSIONS Outcomes after pediatric kidney transplantation have improved dramatically over time for all recipient subgroups, especially for highly sensitized recipients. Most improvement in graft and patient survival has come in the first year after transplantation, highlighting the need for continued progress in long-term outcomes.
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Affiliation(s)
- Kyle J. Van Arendonk
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Babak J. Orandi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan T. James
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jodi M. Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; and
| | - Paul M. Colombani
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;,Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
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9
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Campbell S, Pilmore H, Gracey D, Mulley W, Russell C, McTaggart S. KHA-CARI guideline: recipient assessment for transplantation. Nephrology (Carlton) 2014; 18:455-462. [PMID: 23581832 DOI: 10.1111/nep.12068] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Scott Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital and Department of Medicine, Auckland University, Auckland, New Zealand
| | - David Gracey
- Renal Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - William Mulley
- Department of Nephrology, Monash Medical Centre and Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christine Russell
- Renal Transplantation, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Steven McTaggart
- Child & Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, Queensland, Australia.,Renal Transplantation, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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10
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Chaykovska L, Deger S, Roigas J, Lenz A, Lioudmer P, Kothmann LT, Friedersdorff F, Müller D, Kasper A, Giessing M, Magheli A, Kempkensteffen C, Lingnau A, Fuller TF. Long-term outcomes of living donor kidney transplants in pediatric recipients following laparoscopic vs. open donor nephrectomy. Pediatr Transplant 2012; 16:894-900. [PMID: 23131058 DOI: 10.1111/petr.12008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We compared long-term outcomes of LDKT in pediatric recipients following either laparoscopic (LDN) or ODN. In our retrospective single-center study, we compared 38 pediatric LDKT recipients of a laparoscopically procured kidney with a historic ODN group comprising 17 pediatric recipients. In our center, the first pure laparoscopic non-hand-assisted LDN for a pediatric LDKT recipient was performed in June 2001. Demographic data of donors and recipients were comparable between groups. Mean follow-up was 64 months in the LDN group and 137 months in the ODN group. Patient survival was comparable between groups. Graft survival at one and five yr was 97% (LDN) vs. 94% (ODN) and 91% (LDN) vs. 88% (ODN; p = n.s.), respectively. Serum creatinine at one and five yr was 1.16 ± 0.47 mg/dL (LDN) vs. 1.02 ± 0.38 mg/dL (ODN) and 1.38 ± 0.5 mg/dL (LDN) vs. 1.20 ± 0.41 mg/dL (ODN), respectively. The type and frequency of surgical complications did not differ between groups. DGF and acute rejection rates were similar between groups. In the ODN group, a higher proportion of right donor kidneys was used. In the ODN group, all kidneys had singular arteries, whereas in the LDN group five kidneys had multiple arteries. Arterial multiplicity was associated with a higher incidence of DGF. In our experience, LDN does not compromise long-term graft outcomes in pediatric LDKT recipients. Arterial multiplicity of the donor kidney may be a risk factor for impaired early graft function in the pediatric population.
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Affiliation(s)
- Lyubov Chaykovska
- Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
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11
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Lledó-García E, Hernández-Fernández C, Subirá-Ríos D, Díez-Cordero JM, Durán-Merino R, Herranz-Amo F, Verdú-Tartajo F, Moralejo-Gárate M, Bueno-Chomón G, Ogaya-Pinies G, Morales D, Luque-de Pablos A. Cadaver Donor Kidney Retransplantation in the Pediatric Patient: Complications and Long-Term Outcome. J Urol 2011; 185:2582-5. [DOI: 10.1016/j.juro.2011.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Enrique Lledó-García
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Hernández-Fernández
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Subirá-Ríos
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Maria Díez-Cordero
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ramón Durán-Merino
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Herranz-Amo
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Verdú-Tartajo
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Moralejo-Gárate
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gonzalo Bueno-Chomón
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gabriel Ogaya-Pinies
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dolores Morales
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Augusto Luque-de Pablos
- Departments of Urology and Pediatric Nephrology (DM, ALdP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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12
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Abstract
It has been shown that kidney transplantation results in superior life expectancy and quality of life compared with dialysis treatment for patients with end-stage renal disease. However, kidney transplantation in children differs in many aspects from adult kidney transplantation. This review focuses on specific issues of surgical care associated with kidney transplantation in children, including timing of transplantation, technical considerations, patient and graft survival, growth retardation and post-transplant malignancy. At the same time, there is a large discrepancy between the number of available donor kidneys and the number of patients on the waiting list for kidney transplantation. There is a general reluctance to use paediatric donor kidneys, because of relatively frequent complications such as graft thrombosis and early graft failure. We review the specific aspects of kidney transplantation from paediatric donors such as the incidence of graft thrombosis, hyperfiltration injury and 'en bloc' transplantation of two kidneys from one donor with an excellent long-term outcome, which is comparable with adult donor kidney transplantation. We also discuss the potential use of paediatric non-heart-beating donor kidneys, from donors whose heart stopped beating with the preservation techniques used.
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13
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Early Urologic Complications After Pediatric Renal Transplant: A Single-Center Experience. Transplantation 2008; 86:1560-4. [DOI: 10.1097/tp.0b013e31818b63da] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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