1
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Alvarez A, Montgomery A, Galván NTN, Brewer ED, Rana A. Predicting wait time for pediatric kidney transplant: a novel index. Pediatr Nephrol 2024; 39:2483-2493. [PMID: 38216782 PMCID: PMC11199301 DOI: 10.1007/s00467-023-06232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Over one thousand pediatric kidney transplant candidates are added to the waitlist annually, yet the prospective time spent waiting is unknown for many. Our study fills this gap by identifying variables that impact waitlist time and by creating an index to predict the likelihood of a pediatric candidate receiving a transplant within 1 year of listing. This index could be used to guide patient management by giving clinicians a potential timeline for each candidate's listing based on a unique combination of risk factors. METHODS A retrospective analysis of 3757 pediatric kidney transplant candidates from the 2014 to 2020 OPTN/UNOS database was performed. The data was randomly divided into a training set, comprising two-thirds of the data, and a testing set, comprising one-third of the data. From the training set, univariable and multivariable logistic regressions were used to identify significant predictive factors affecting wait times. A predictive index was created using variables significant in the multivariable analysis. The index's ability to predict likelihood of transplantation within 1 year of listing was validated using ROC analysis on the training set. Validation of the index using ROC analysis was repeated on the testing set. RESULTS A total of 10 variables were found to be significant. The five most significant variables include the following: blood group, B (OR 0.65); dialysis status (OR 3.67); kidney disease etiology, SLE (OR 0.38); and OPTN region, 5 (OR 0.54) and 6 (OR 0.46). ROC analysis of the index on the training set yielded a c-statistic of 0.71. ROC analysis of the index on the testing set yielded a c-statistic of 0.68. CONCLUSIONS This index is a modest prognostic model to assess time to pediatric kidney transplantation. It is intended as a supplementary tool to guide patient management by providing clinicians with an individualized prospective timeline for each candidate. Early identification of candidates with potential for prolonged waiting times may help encourage more living donation including paired donation chains.
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Affiliation(s)
- Alexandra Alvarez
- Office of Student Affairs, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Ashley Montgomery
- Office of Student Affairs, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Nhu Thao Nguyen Galván
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eileen D Brewer
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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2
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Crawford B, Kizilbash S, Bhatia VP, Kulsum-Mecci N, Cannon S, Bartosh SM. Native nephrectomy in advanced pediatric kidney disease: indications, timing, and surgical approaches. Pediatr Nephrol 2024; 39:1041-1052. [PMID: 37632524 DOI: 10.1007/s00467-023-06117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/28/2023]
Abstract
In pediatric kidney failure, native kidneys may pose a risk to successful transplant outcomes. The indications and timing of native nephrectomy represent a controversial management decision. A lack of high-quality, outcomes-based data has prevented development of evidence-based guidelines for intervention. In this article, we review the published literature on medical indications for native nephrectomy and current knowledge gaps. In addition, we provide a surgical perspective regarding timing and approach.
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Affiliation(s)
- Brendan Crawford
- Department of Pediatrics, Division of Nephrology, University of Arkansas Medical Sciences, Little Rock, AR, USA.
| | - Sarah Kizilbash
- Department of Pediatrics, Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Vinaya P Bhatia
- Department of Urology, Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nazia Kulsum-Mecci
- Department of Pediatrics, Division of Nephrology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Shannon Cannon
- Department of Urology, Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon M Bartosh
- Department of Pediatrics, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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3
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Alhasan KA, Sethi SK, Broering DC. Kidney transplants in small children: Weighing the pros and cons. Pediatr Transplant 2024; 28:e14647. [PMID: 37975180 DOI: 10.1111/petr.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Khalid A Alhasan
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Dieter Clemens Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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4
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Kilduff S, Steinman B, Hayde N. Changes in graft outcomes in recipients <10 kg over 25 years of pediatric kidney transplantation in the United States. Pediatr Transplant 2024; 28:e14679. [PMID: 38149338 PMCID: PMC10872313 DOI: 10.1111/petr.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Kidney transplant (KT) was initially associated with poor outcomes, especially in smaller recipients. However, pediatric transplantation has evolved considerably over time. We investigated the impact of weight at the time of transplant and whether outcomes changed over 25 years for <10 kg recipients. METHODS Using the UNOS database, pediatric recipient outcomes were analyzed between 1/1/99 and 12/31/14. KT weight was stratified: <8.6 kg (mean weight of recipients <10 kg), 8.6-9.9 kg, 10-14.9 kg, 15-29.9 kg, and ≥30 kg. Outcomes in recipients <10 kg were then compared between 1990-1999 and 2000-2014. RESULTS 17 314 pediatric KT recipients were included; 518 (3%) had a transplant weight <10 kg. The highest rates of allograft loss and death were in recipients <8.6 kg and ≥30 kg. Recipients <8.6 kg also had higher rates of delayed graft function, rejection, and longer hospital length of stay. In the multivariable Cox regression model, transplant weight was not a predictor of allograft loss. When compared with recipients <8.6 kg, patient survival hazard ratios associated with recipient weight of 10-14.9 kg, 15-29.9 kg, and ≥30 kg were 0.61 (95%CI: 0.4, 1), 0.42 (95%CI: 0.3, 0.7) and 0.32 (95%CI: 0.2, 0.6), respectively. In the later era of transplant, recipients <10 kg had improved outcomes on univariate analysis; however, the era of transplantation was not an independent predictor of allograft loss or patient survival in Cox regression models. CONCLUSIONS Outcomes in children weighing 8.6-9.9 kg at the time of KT were similar to higher weight groups and improved over time; however, special precautions should be taken for recipients <8.6 kg at the time of transplant.
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Affiliation(s)
- Stella Kilduff
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin Steinman
- Robert Wood Johnson Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Nicole Hayde
- The Children's Hospital at Montefiore/Einstein, Bronx, New York, USA
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5
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Puliyanda D, Barday Z, Barday Z, Freedman A, Todo T, Chen AKC, Davidson B. Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics. Semin Nephrol 2023; 43:151442. [PMID: 37949683 DOI: 10.1016/j.semnephrol.2023.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Kidney transplantation is the treatment of choice for all patients with end-stage kidney disease, including pediatric patients. Graft survival in pediatrics was lagging behind adults, but now is comparable with the adult cohort. Although many of the protocols have been adopted from adults, there are issues unique to pediatrics that one should be aware of to take care of this population. These issues include recipient size consideration, increased incidence of viral infections, problems related to growth, common occurrence of underlying urological issues, and psychosocial issues. This article addresses the similarities and differences in renal transplantation, from preparing a patient for transplant, the transplant process, to post-transplant complications.
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Affiliation(s)
- Dechu Puliyanda
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA.
| | - Zibya Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Zunaid Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Freedman
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Tsuyoshi Todo
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Allen Kuang Chung Chen
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Bianca Davidson
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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6
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Evans-Barns H, Mushtaq I, Michell I, Kausman J, Webb N, Taghavi K. Paediatric kidney transplantation: Towards a framework for pretransplant urological evaluation. Pediatr Transplant 2022; 26:e14299. [PMID: 35587393 DOI: 10.1111/petr.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
The role of the urologist in paediatric kidney transplantation has evolved alongside advances in management for the various causes of end-stage kidney disease. Improvements in antenatal intervention and postnatal care have seen children with increasingly complex urological anomalies survive until transplant. Once solely responsible for the oversight of a child's surgical care, the paediatric urologist now works within a multidisciplinary transplant team, alongside transplant surgeons, paediatric nephrologists, transplant coordinators, psychologists, social workers, and transitional care specialists. We sought to identify available pretransplant evaluation frameworks to guide urological preparation and decision-making. Drawing from available evidence and reflecting on multi-institutional experience, we propose a streamlined approach to urologic assessment, which recognises that optimal transplant outcomes in this heterogenous cohort require lower urinary tract dysfunction to be carefully defined preoperatively.
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Affiliation(s)
- Hannah Evans-Barns
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Ian Michell
- Department of Renal Transplant Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Joshua Kausman
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Nathalie Webb
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
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7
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Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W. Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades. Front Pediatr 2022; 10:856630. [PMID: 35463874 PMCID: PMC9024248 DOI: 10.3389/fped.2022.856630] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.
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Affiliation(s)
- Loes Oomen
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Charlotte Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatrics, Pediatric Nephrology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Cornelissen
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Liesbeth de Wall
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Wout Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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8
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Fernandez HE, Foster BJ. Long-Term Care of the Pediatric Kidney Transplant Recipient. Clin J Am Soc Nephrol 2022; 17:296-304. [PMID: 33980614 PMCID: PMC8823932 DOI: 10.2215/cjn.16891020] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize the transition to adult-oriented transplant care and long-term outcomes.
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Affiliation(s)
- Hilda E. Fernandez
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bethany J. Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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9
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Loubersac T, Roussey G, Dengu F, Langlois d'Estaintot H, Pere M, Glémain P, Rigaud J, Leclair MD, Karam G, Branchereau J. Comparison of the outcomes of the pediatric kidney transplantation between recipients below and above 15 kg: a single center retrospective study. World J Urol 2021; 39:2789-2794. [PMID: 33388915 DOI: 10.1007/s00345-020-03537-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The renal transplantation is the best treatment for end-stage renal disease in children. We present the findings of an analysis of our institution's paediatric transplant outcomes comparing recipients under 15 kg, who represent this potentially higher risk group, to those above 15 kg. METHODS We retrospectively identified consecutive paediatric kidney transplants from a prospectively collected database for analysis. We included all recipients under the age of 18 years at the time of transplant between 2006 and 2018 without any exclusion criteria. The primary outcome was death-censored graft survival at 1 year, 5 years and 10 years. RESULTS 109 paediatric kidney transplants were performed in 100 children. Graft survival in the all population was 98%, 96% and 76% at 1 year, 5 years and 10 years, respectively. Recipient weight below 15 kg was not found to be a risk factor of graft loss. Overall, we found no individual factor to be statistically significantly associated with renal graft lost. The overall complication rate was 16% (18/109) with 12 early complications (11%) and 6 late ones (5%). CONCLUSION Kidney transplantation in children weighing < 15 kg seems safe and offers the same patient and graft survival outcomes as in other (> 15 kg) pediatric recipients with equally low complication rates.
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Affiliation(s)
- Thomas Loubersac
- Urology, University Hospital of Nantes, Nantes, France. .,Pediatric Urology Unit, University Hospital of Nantes, 1 place Alexis Ricordeau, Nantes, France.
| | | | - Fungai Dengu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Morgane Pere
- Biostatistics Unit, University Hospital of Nantes, Nantes, France
| | | | - Jérôme Rigaud
- Urology, University Hospital of Nantes, Nantes, France
| | - Marc-David Leclair
- Pediatric Urology Unit, University Hospital of Nantes, 1 place Alexis Ricordeau, Nantes, France
| | - Georges Karam
- Urology, University Hospital of Nantes, Nantes, France
| | - Julien Branchereau
- Urology, University Hospital of Nantes, Nantes, France.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Centre de Recherche en Transplantation Et Immunologie, UMR1064, INSERM, Université de Nantes, Nantes, France
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10
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Muramatsu M, Mizutani T, Hamasaki Y, Takahashi Y, Itabashi Y, Kubota M, Hashimoto J, Oguchi H, Sakurabayashi K, Hyodo Y, Shinoda K, Kawamura T, Sakai K, Shishido S. Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience. Pediatr Transplant 2019; 23:e13401. [PMID: 30916370 DOI: 10.1111/petr.13401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/20/2019] [Accepted: 02/13/2019] [Indexed: 01/22/2023]
Abstract
RTx of adult-size kidneys presents a size mismatch in small pediatric recipients, and there are potential surgical complications. This study reveals the outcomes of intra- and extraperitoneal RTx in low-weight (less than 15 kg) pediatric recipients. We studied 51 pediatric patients weighing less than 15 kg who received a living-related donor renal transplant between 2009 and 2017. The intraperitoneal (group A, n = 24) and extraperitoneal (group B, n = 27) approaches were compared. In group A, the mean age, Ht, and weight were 3.8 ± 1.6 years, 83.7 ± 6.5 cm, 10.5 ± 1.8 kg; in group B, 5.0 ± 1.9 years, 95.3 ± 7.3 cm, and 13.0 ± 1.4 kg. Single renal artery grafts (21 in group A and 16 in group B) and double renal artery grafts (three in group A and 11 in group B) were performed. Of the patients with double renal artery transplants, one in group A and six in group B underwent ex vivo arterial reconstruction. The eGFR (mL/min/1.73 m2 ) at 1-week post-transplant in group A was significantly higher than that in group B; the eGFRs at 4 weeks post-transplant did not differ. One graft was lost in group B because of vascular thrombosis. Post-transplant complications included ileus and transplant ureteral stenosis. There was no significant difference in 5-year graft survival rate (group A 100%, group B 91.7%). Both transplant approaches are feasible to adapt to a size mismatch between the adult-size donor kidney and low-weight pediatric recipients.
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Affiliation(s)
- Masaki Muramatsu
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Toshihide Mizutani
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoshihiro Itabashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Mai Kubota
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Junya Hashimoto
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hideyo Oguchi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kei Sakurabayashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoji Hyodo
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
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11
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Goh CYY, Hume-Smith H, Kessaris N, Marks SD. A case series of perioperative variables in relation to short-term outcomes in pediatric renal transplant recipients. Pediatr Transplant 2018; 22:e13198. [PMID: 29729082 DOI: 10.1111/petr.13198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 12/01/2022]
Abstract
Multiple perioperative variables have been shown in existing literature to influence long-term outcomes of pediatric RTx, such as allograft survival. Their impact on short-term outcomes is not as well-documented. This case series aims to investigate the effects of nine perioperative variables on two short-term outcomes in pRTR: 1-week post-operative eGFR and post-operative LOS. A total of 73 pRTR transplanted over 3 years from 2012 to 2014 at a single center were studied retrospectively and statistical analyses were performed. There was higher 1-week post-operative eGFR in pRTR who received living donor transplants compared to those who received deceased donor transplants (P=.01), with mean eGFR of 135 mL/min/1.73 m2 and 82 mL/min/1.73 m2 , respectively. Aorta-IVC anastomosis was associated with longer LOS compared to iliac vessel anastomosis (P=.03), with median LOS of 19 and 13 days, respectively. There were no significant effects on 1-week eGFR or LOS of the seven other variables: pRTR age and gender, donor age, preoperative donor SBP, intraoperative mean CVP before graft perfusion, intraoperative median SBP z score after graft perfusion, and intraoperative fluid volume. Living donor transplants were associated with higher 1-week post-operative eGFR compared to deceased donor transplants. Aorta-IVC anastomosis was significantly associated with longer LOS compared to iliac vessel anastomosis.
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Affiliation(s)
| | - Helen Hume-Smith
- Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK
| | - Nicos Kessaris
- Department of Renal Transplantation, Guy's Hospital, London, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
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12
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Cho MH. Pediatric kidney transplantation is different from adult kidney transplantation. KOREAN JOURNAL OF PEDIATRICS 2018; 61:205-209. [PMID: 30032586 PMCID: PMC6106688 DOI: 10.3345/kjp.2018.61.7.205] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
Kidney transplantation (KT) is the gold standard for renal replacement therapy in pediatric patients with end-stage renal disease. Recently, it has been observed that the outcome of pediatric KT is nearly identical to that in adults owing to the development and application of a variety of immunosuppressants and newer surgical techniques. However, owing to several differences in characteristics between children and adults, pediatric KT requires that additional information be learned and is associated with added concerns. These differences include post-KT complications, donor-recipient size mismatch, problems related to growth, and nonadherence to therapy, among others. This review was aimed at elucidating the clinical characteristics of pediatric KT that differ from those observed in adults.
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Affiliation(s)
- Min Hyun Cho
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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13
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Shelton BA, Sawinski D, Ray C, Reed RD, MacLennan PA, Blackburn J, Young CJ, Gray S, Yanik M, Massie A, Segev DL, Locke JE. Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system. Am J Transplant 2018; 18:1690-1698. [PMID: 29333639 DOI: 10.1111/ajt.14663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 01/25/2023]
Abstract
The Kidney Allocation System (KAS) was implemented in December 2014 with unknown impact on the pediatric waitlist. To understand the effect of KAS on pediatric registrants, deceased donor kidney transplant (DDKT) rate was assessed using interrupted time series analysis and time-to-event analysis. Two allocation eras were defined with an intermediary washout period: Era 1 (01/01/2013-09/01/2014), Era 2 (09/01/2014-03/01/2015), and Era 3(03/01/2015-03/01/2017). When using Cox proportional hazards, there was no significant association between allocation era and DDKT likelihood as compared to Era 1 (Era 3: aHR: 1.07, 95% CI: 0.97-1.18, P = .17). However, this was not consistent across all subgroups. Specifically, while highly sensitized pediatric registrants were consistently less likely to be transplanted than their less sensitized counterparts, this disparity was attenuated in Era 3 (Era 1 aHR: 0.04, 95%CI: 0.01-0.14, P < .001; Era 3 aHR: 0.33, 95% CI: 0.21-0.53, P < .001) whereas the youngest registrants aged 0-6 experienced a 21% decrease in DDKT likelihood in Era 3 as compared to Era 1 (aHR: 0.79, 95% CI: 0.64-0.98, P = .03). Thus, while overall DDKT likelihood remained stable with the introduction of KAS, registrants ≤ 6 years of age were disadvantaged, warranting further study to ensure equitable access to transplantation.
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Affiliation(s)
- Brittany A Shelton
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deirdre Sawinski
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Ray
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul A MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Justin Blackburn
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlton J Young
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Gray
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan Yanik
- Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allan Massie
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
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Odeh RI, Sidler M, Skelton T, Zu'bi F, Naoum NK, Azzawayed IA, Alyami FA, Lorenzo AJ, Farhat WA, Koyle MA. Intraoperative blood transfusion in pediatric patients undergoing renal transplant-Effect of renal graft size. Pediatr Transplant 2018; 22:e13119. [PMID: 29488289 DOI: 10.1111/petr.13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Abstract
In pediatric RT, donor allograft size often exceeds the expected recipient norms, especially in younger recipients. An "oversize" graft might not only present a technical- and space-related challenge, but may possibly lead to increased demands in perioperative volume requirements due to the disparity between donor and recipient in renal blood flow. We evaluated transfusion practices at a single tertiary institution with special consideration of kidney graft size, hypothesizing that oversize graft kidneys might lead to a quantifiable increased need of blood transfusion in smaller recipients. Retrospective analysis of all patients who underwent pediatric RT from January 2004 to June 2014 at a tertiary pediatric centre was performed. Variables analyzed included patient age, weight, pre- and postoperative Hb concentration, graft size, EBL, amount of intraoperative blood transfusion, and preoperative use of erythropoietin. Based on graft size in relation to patient's age, a SMR and an OvR were identified. A subcohort of age-matched pairs was used to allow for comparison between groups. We calculated the expected procedure- and transfusion-induced changes in Hb and compared these changes to the observed difference in pre- vs postoperative Hb to assess the influence of graft size on transfusion requirements. RT was performed in 188 pediatric recipients during the study period. In the matched cohort, percentage of transfused patients during transplantation in the OvR group was more than double compared with SMR (89% vs 39%, P < .001); similarly, the median number of transfused PRBC units in OvR was 1, while the median of SMR did not receive transfusion (P < .001). The difference between expected (calculated) and observed change in Hb was significantly higher in OvR with a median of 1.9 g/dL compared with SMR with a median of 1.0 g/dL (P = .026). Correspondingly, the calculated median volume taken up by a regular size kidney was significantly higher with 213 mL compared with 313 mL (P = .031) taken up by an oversize graft kidney. Median estimated intraoperative blood loss was significantly higher in OvR than in SMR (6.9 mL/kg, vs 5.3 mL/kg, respectively; P = .04). Median postoperative Hb was similar among groups (10.4 g/dL vs 10.6 g/dL for SMR vs OvR, respectively). Transplantation of an oversized kidney in pediatric RT recipients is associated with a quantifiable higher need for blood transfusion. This may be caused by a higher intraoperative EBL and/or greater blood volume sequestered by the larger renal allograft and requires further evaluation.
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Affiliation(s)
- Rakan I Odeh
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Martin Sidler
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.,Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Teresa Skelton
- Department of Pediatric Anesthesia, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fadi Zu'bi
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Naimet K Naoum
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Ibraheem Abu Azzawayed
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fahad A Alyami
- Division of Urology, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Walid A Farhat
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
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Kloesel B, Verghese PS, Belani K. Issues in Pediatric Kidney Transplantation. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0269-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Haasova M, Snowsill T, Jones-Hughes T, Crathorne L, Cooper C, Varley-Campbell J, Mujica-Mota R, Coelho H, Huxley N, Lowe J, Dudley J, Marks S, Hyde C, Bond M, Anderson R. Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation. Health Technol Assess 2018; 20:1-324. [PMID: 27557331 DOI: 10.3310/hta20610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND End-stage renal disease is a long-term irreversible decline in kidney function requiring kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation followed by induction and maintenance immunosuppressive therapy to reduce the risk of kidney rejection and prolong graft survival. OBJECTIVES To systematically review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect,(®) Novartis Pharmaceuticals) and rabbit antihuman thymocyte immunoglobulin (Thymoglobuline,(®) Sanofi) as induction therapy and immediate-release tacrolimus [Adoport(®) (Sandoz); Capexion(®) (Mylan); Modigraf(®) (Astellas Pharma); Perixis(®) (Accord Healthcare); Prograf(®) (Astellas Pharma); Tacni(®) (Teva); Vivadex(®) (Dexcel Pharma)], prolonged-release tacrolimus (Advagraf,(®) Astellas Pharma); belatacept (BEL) (Nulojix,(®) Bristol-Myers Squibb), mycophenolate mofetil (MMF) [Arzip(®) (Zentiva), CellCept(®) (Roche Products), Myfenax(®) (Teva), generic MMF is manufactured by Accord Healthcare, Actavis, Arrow Pharmaceuticals, Dr Reddy's Laboratories, Mylan, Sandoz and Wockhardt], mycophenolate sodium, sirolimus (Rapamune,(®) Pfizer) and everolimus (Certican,(®) Novartis Pharmaceuticals) as maintenance therapy in children and adolescents undergoing renal transplantation. DATA SOURCES Clinical effectiveness searches were conducted to 7 January 2015 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science [via Institute for Scientific Information (ISI)], Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (HTA) (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted to 15 January 2015 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Databases (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and EconLit (via EBSCOhost). REVIEW METHODS Titles and abstracts were screened according to predefined inclusion criteria, as were full texts of identified studies. Included studies were extracted and quality appraised. Data were meta-analysed when appropriate. A new discrete time state transition economic model (semi-Markov) was developed; graft function, and incidences of acute rejection and new-onset diabetes mellitus were used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death. RESULTS Three randomised controlled trials (RCTs) and four non-RCTs were included. The RCTs only evaluated BAS and tacrolimus (TAC). No statistically significant differences in key outcomes were found between BAS and placebo/no induction. Statistically significantly higher graft function (p < 0.01) and less biopsy-proven acute rejection (odds ratio 0.29, 95% confidence interval 0.15 to 0.57) was found between TAC and ciclosporin (CSA). Only one cost-effectiveness study was identified, which informed NICE guidance TA99. BAS [with TAC and azathioprine (AZA)] was predicted to be cost-effective at £20,000-30,000 per quality-adjusted life year (QALY) versus no induction (BAS was dominant). BAS (with CSA and MMF) was not predicted to be cost-effective at £20,000-30,000 per QALY versus no induction (BAS was dominated). TAC (with AZA) was predicted to be cost-effective at £20,000-30,000 per QALY versus CSA (TAC was dominant). A model based on adult evidence suggests that at a cost-effectiveness threshold of £20,000-30,000 per QALY, BAS and TAC are cost-effective in all considered combinations; MMF was also cost-effective with CSA but not TAC. LIMITATIONS The RCT evidence is very limited; analyses comparing all interventions need to rely on adult evidence. CONCLUSIONS TAC is likely to be cost-effective (vs. CSA, in combination with AZA) at £20,000-30,000 per QALY. Analysis based on one RCT found BAS to be dominant, but analysis based on another RCT found BAS to be dominated. BAS plus TAC and AZA was predicted to be cost-effective at £20,000-30,000 per QALY when all regimens were compared using extrapolated adult evidence. High-quality primary effectiveness research is needed. The UK Renal Registry could form the basis for a prospective primary study. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013544. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- Marcela Haasova
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Tracey Jones-Hughes
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Nicola Huxley
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jenny Lowe
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children (University Hospitals Bristol NHS Foundation Trust), Bristol, UK
| | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Mary Bond
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
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Chiodini B, Herman J, Lolin K, Adams B, Hennaut E, Lingier P, Mikhalski D, Schurmans T, Knops N, Wissing KM, Abramowicz D, Ismaili K. Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study. Transpl Int 2018; 31:720-728. [DOI: 10.1111/tri.13108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/12/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Benedetta Chiodini
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Jean Herman
- Department of Pediatric Nephrology and Solid Organ Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Ksenija Lolin
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Brigitte Adams
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Elise Hennaut
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Pierre Lingier
- Renal transplant Unit; Erasme Hospital; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Dimitri Mikhalski
- Renal transplant Unit; Erasme Hospital; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Thierry Schurmans
- Department of Pediatrics; Hôpital Universitaire Civil Marie Curie; Université Libre de Bruxelles (ULB); Charleroi Belgium
| | - Noël Knops
- Department of Pediatric Nephrology and Solid Organ Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Karl M. Wissing
- Department of Nephrology; UZ Brussel-VUB; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Daniel Abramowicz
- Department of Nephrology; Antwerp University Hospital and Antwerp University; Antwerp Belgium
| | - Khalid Ismaili
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
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19
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Pediatric kidney transplantation: a historical review. Pediatr Res 2017; 81:259-264. [PMID: 27732587 DOI: 10.1038/pr.2016.207] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/30/2016] [Indexed: 01/10/2023]
Abstract
Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation (vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.
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20
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Radtke J, Lemke A, Kemper MJ, Nashan B, Koch M. Surgical complications after peritoneal dialysis catheter implantation depend on children's weight. J Pediatr Surg 2016; 51:1317-20. [PMID: 26775194 DOI: 10.1016/j.jpedsurg.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/30/2015] [Accepted: 12/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical complications are estimated to be as high as 30%-40% during the first 8 weeks after implantation of peritoneal dialysis (PD) catheters. METHODS 70 PD catheters which were implanted by transplant surgeons in 61 children (median age 3.3years, range 0.01-15.5years, 31 boys and 30 girls) in 2009-2014 were retrospectively reviewed. The incidence of complications and revisions during the first 6months after implantation was analyzed depending on children's weight and diagnosis. RESULTS 17 out of 70 catheters needed a surgical revision within 6months after implantation (24.3%). Peritonitis was the most common complication affecting 18.6% of peritoneal dialysis catheters followed by obstruction and dislocation, which it occurred in 9 (12.9%) and 7 (10%) catheters, respectively. Leakage (n=5) only occurred in children with a weight of less than 10kg. The total proportion of complications was higher in children with less than 10kg of weight (P<0.001). CONCLUSION PD is safe in children with acute renal failure and older children with chronic renal failure; however children with a weight of less than 10kg are more likely to develop complications.
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Affiliation(s)
- Josephine Radtke
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anja Lemke
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Markus J Kemper
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Bjoern Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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21
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Jalanko H, Mattila I, Holmberg C. Renal transplantation in infants. Pediatr Nephrol 2016; 31:725-35. [PMID: 26115617 DOI: 10.1007/s00467-015-3144-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 01/28/2023]
Abstract
Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.
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Affiliation(s)
- Hannu Jalanko
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland.
| | - Ilkka Mattila
- Department of Cardiac and Transplantation Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christer Holmberg
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland
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22
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Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period. Kidney Int 2014; 86:168-74. [DOI: 10.1038/ki.2013.561] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 01/06/2023]
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23
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Zurowska AM, Fischbach M, Watson AR, Edefonti A, Stefanidis CJ. Clinical practice recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). Pediatr Nephrol 2013; 28:1739-48. [PMID: 23052647 PMCID: PMC3722439 DOI: 10.1007/s00467-012-2300-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 11/04/2022]
Abstract
BACKGROUND To provide recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). SETTING European Paediatric Dialysis Working Group. DATA SOURCES Literature on clinical studies involving infants with CKD5 (end stage renal failure) and consensus discussions within the group. RECOMMENDATIONS There has been an important change in attitudes towards offering RRT (renal replacement therapy) to both newborns and infants as data have accumulated on their improved survival and long-term outcomes. The management of this challenging group of patients differs in a number of ways from that of older children. The authors have summarised the basic recommendations for treating infants with CKD5 in order to support the multidisciplinary teams who endeavour on this difficult task.
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Affiliation(s)
- Aleksandra M Zurowska
- Department Paediatric & Adolescent Nephrology & Hypertension, Medical University of Gdansk, Ul. Debinki 7, 80-211, Gdansk, Poland.
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Huang PC, Yang CY, Lee CY, Yeh CC, Lai IR, Tsau YK, Hu RH, Tsai MK, Lee PH. Pediatric renal transplantation: results and prognostic factors. Asian J Surg 2013; 36:53-7. [PMID: 23522755 DOI: 10.1016/j.asjsur.2012.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/04/2012] [Accepted: 09/06/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE As renal transplantation may increase survival rates and improve quality of life for children with end-stage renal disease, we investigated the long-term outcomes and prognostic factors of pediatric renal transplantation. METHODS A retrospective study was conducted to review 25 pediatric renal transplantations, either from live or deceased donors, in our hospital from 1995 to 2008. The cumulative graft survival rate was calculated using the Kaplan-Meier method. Log rank tests were employed to identify categorical prognostic factors for graft survival of the pediatric renal transplantations, and Cox regression analysis for numeric factors. RESULTS The mean age of our study subjects was 11.63±3.76 years, and the mean follow-up period was 49.24±33.72 months. The 12-month and 36-month graft survival rates were 92% and 82.14%, respectively. The rejection-free survival rates were 88% and 72.88% in the first and third years, respectively. All of the patients were alive during the follow-up period. Acute rejection (p=0.0175) and male sex (p=0.0384) were found to be significant factors for graft survival. CONCLUSION For pediatric patients, we found that renal transplantation is now a safe and effective surgical procedure for children with end-stage renal disease. Acute rejection and male gender were identified as prognostic factors for poor graft survival.
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Affiliation(s)
- Po-Cheng Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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25
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Rödl S, Marschitz I, Mache CJ, Nagel B, Koestenberger M, Zobel G. Hemodiafiltration in infants with complications during peritoneal dialysis. Artif Organs 2012; 36:590-3. [PMID: 22428733 DOI: 10.1111/j.1525-1594.2011.01434.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
End-stage renal disease (ESRD) in neonates still has a high mortality, particularly in the first year of life. We present the combination of peritoneal dialysis (PD) with intermittent hemodiafiltration (iHDF) in neonates with ESRD. Four infants younger than 28 days were treated with PD and iHDF. Renal diagnoses leading to ESRD were cortical necrosis, prune belly syndrome, neonatal hemolytic uremic syndrome, and autosomal recessive polycystic kidney disease. Initially, three patients were on iHDF until PD was started. At the time when complications occurred during PD, patients were switched back to iHDF. iHDF was used five times as a bridge to PD in case of abdominal surgery. Two of the four patients were switched to iHDF because of peritoneal ultrafiltration failure due to recurrent peritoneal leaks. Once, iHDF became necessary due to refractory peritonitis. All four patients survived the first year of life. Two patients were transplanted successfully at an age of 35 and 22 months, respectively. The others are on renal replacement therapy, one on PD at the age of 28 months and one on iHDF at the age of 25 months, respectively. In case of PD complications, iHDF may be an appropriate bridge to achieve long-term survival until kidney transplantation.
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Affiliation(s)
- Siegfried Rödl
- Pediatric Intensive Care Unit, Department of Pediatrics, Medical University of Graz, Graz, Austria.
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26
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Ranchin B, Demede D, Javouhey E, Basmaison O, Cejka JC, Bertholet-Thomas A, Hameury F, Martin X, Cochat P, Badet L. [Kidney transplantation in childhood: from milimeter to centimeters]. Nephrol Ther 2011; 7:604-7. [PMID: 22118790 DOI: 10.1016/j.nephro.2011.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Graft survival is worse in recipient aged less than 5 years due to the greater risk of vascular thrombosis. Thrombosis may be prevented by the choice of the donor, method of surgery, perioperative hemodynamic optimisation and preventive anti-coagulation. Normal growth is a major objective of the management of transplanted children. The mean final height increased during the 20 last years to be between -1.63 and -0.92 SDS depending on age and period of the transplantation.
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Affiliation(s)
- Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon et Université de Lyon.
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Wedekin M, Ehrich JHH, Offner G, Pape L. Renal replacement therapy in infants with chronic renal failure in the first year of life. Clin J Am Soc Nephrol 2009; 5:18-23. [PMID: 19965536 DOI: 10.2215/cjn.03670609] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although results of renal replacement therapy (RRT) in small children have improved during recent years, data about RRT in neonates are scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a retrospective study, we analyzed the outcome of infants who had chronic kidney disease and started RRT within their first year of life. Between 1997 and 2008, all 29 infants who were younger than 1 yr, had end-stage renal failure, and underwent RRT (dialysis or transplantation) at Hannover Medical School were analyzed for up to 12 yr. RESULTS Twenty-seven of 29 infants with chronic kidney disease received peritoneal dialysis, starting at a mean age of 112 d; two children received preemptive renal transplantation (RTx). During follow-up, 21 of 29 children survived with RTx. The 5-yr patient and graft survival rate after RTx was 95.5%. Six of 29 children died, one with a functioning graft and five while on peritoneal dialysis. The main causes of death were severe cardiovascular and cerebral comorbidities. The mean GFR at last follow-up of patients who underwent RTx (mean time after RTx 5.1 yr) was 63.2 ml/min per 1.73 m(2). CONCLUSIONS RRT in infants who are younger than 1 year offers excellent chances of survival and should be offered to all infants who do not have severe, life-limiting extrarenal comorbidity. Contrary to previous observations, the long-term outcome of infants may be comparable to that of older children who undergo RRT.
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Affiliation(s)
- Mirja Wedekin
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany
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Mekahli D, Shaw V, Ledermann SE, Rees L. Long-term outcome of infants with severe chronic kidney disease. Clin J Am Soc Nephrol 2009; 5:10-7. [PMID: 19965538 DOI: 10.2215/cjn.05600809] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES In 2000, we reported the outcome of 101 children with a GFR <20 ml/min per 1.73 m2 at 0.3 yr of age (range 0.0 to 1.5 yr). Long-term data on such young children are scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Mortality, treatment modalities, and growth were reanalyzed 9.9 yr later. RESULTS Of the 101 patients, 28 died and three were lost to follow-up during 13.90 yr (range 0.03 to 22.90 yr). One-, 2-, 5-, 10-, 15-, 20-, and 22-yr survivals were 87, 81, 77, 75, 73, 72, and 64%, respectively. Fifty-one children had comorbidities. Sixty-six percent were tube fed for 1.7 yr (range 0.1 to 6.9 yr), 37% had a gastrostomy, and 13% had a Nissen fundoplication. Mean height SD score (SD) was -0.42 (2.33) at birth (n = 40), -2.07 (1.34) at 0.5 (n = 62), -1.93 (1.38) at 1 (n = 72), -1.14 (1.14) at 5 (n = 67), -1.04 (1.15) at 10 (n = 62), -1.84 (1.32) at 15 (n = 40), and -1.68 (1.52) at age > or =18 yr (n = 32). Comorbidities adversely influenced growth (P < 0.01) and final height (P = 0.02): Mean height SD score (SD) was -1.16 (1.38) in otherwise normal adults. CONCLUSIONS Growth and final height in infants with severe chronic kidney disease are influenced by comorbidity. Intensive feeding and early transplantation resulted in a mean adult height within the normal range in patients without comorbidities. Overall mortality is comparable to that of older children.
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Affiliation(s)
- Djalila Mekahli
- Renal Office, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
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Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease. Pediatr Nephrol 2009; 24:2035-9. [PMID: 19526253 DOI: 10.1007/s00467-009-1234-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/19/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
This study evaluates the long-term outcomes of infants with end stage renal disease (ESRD) who required initiation of chronic peritoneal dialysis (PD) prior to 28 days of age. Infants with ESRD present both ethical and technical challenges for pediatric nephrologists and neonatologists. Recent advances in the medical management of ESRD in infants combined with improved infant transplantation outcomes make it more likely that such infants can survive to successful kidney transplantation. We reviewed all infants initiating PD for ESRD before 28 days of age at the University of Minnesota Amplatz Children's Hospital from 1995 to 2004 (n = 23). Overall 1 - and 5-year patient survival was 52 and 48%, respectively. Twelve children received kidney transplants at a median age and weight of 1.12 years and 9.5 kg, respectively, with a 5-year graft survival rate of 83%. In summary, a majority of infants requiring renal replacement therapy with PD in the first month of life achieve long-term survival with a successful kidney transplant.
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30
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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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31
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Abstract
PURPOSE OF REVIEW The pediatric patient with end-stage renal disease provides a great opportunity for the involvement of the pediatric urologist because of the high incidence of associated urologic anomalies. RECENT FINDINGS Renal transplant remains the procedure of choice in the child with end-stage renal disease. The durability of survival of the graft is impacted by successful management of the genitourinary tract. SUMMARY Preoperative, intraoperative, and postoperative evaluation is critical for the child with associated urologic disease and end-stage renal disease. Early and appropriate management may stabilize renal function and prolong the time to transplant. Due to the relatively long life expectancy of children compared with adults with end-stage renal disease, appropriate management may be of benefit to avoid the morbidity associated with renal replacement therapy. In certain children, the appropriate management and reconstruction of the genitourinary tract may allow for a planned and preemptive renal transplant, thus avoiding dialysis.
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