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Clinical Accuracy of Average Creatinine and Cystatin-C-Based Estimated GFR in Japanese Living Renal Transplantation Donors. Transplant Proc 2020; 52:3017-3022. [PMID: 32711850 DOI: 10.1016/j.transproceed.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the clinical accuracy of several estimated glomerular filtration rates (eGFR) using cystatin-C to measure renal function in Japanese renal donors. METHODS In total, 61 healthy, potential renal donors were assessed. The average age was 42.7 years (range: 27-67). We evaluated the GFR based on the 24-hour creatinine clearance (Ccr) using 24-hour urine collection, eGFR based on serum creatinine (eGFRcr), and cystatin-C (eGFRcys) levels using an equation developed by the Japanese Society of Nephrology, the average of the eGFRcr and eGFRcys (eGFRave) rates, and an eGFR based on a combination of serum creatinine and cystatin-C values using an equation developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). The association between Ccr and each eGFR was evaluated using Pearson's r and the Bland-Altman plot. RESULTS Pearson's correlation coefficient analysis revealed a significant correlation between the Ccr and the eGFRcr (r = 0.62, P < .0001), eGFRave (r = 45, P = .0003), and eGFRcr-cys (r = 0.451, P = .0014). The Bland-Altman study suggested that each eGFR had a low level of agreement with the Ccr because the latter was higher than each eGFR. On the other hand, the eGFRave had the highest level of agreement with CCr × 0.715. CONCLUSIONS The eGFRave may provide a simple and useful method of evaluating renal function in living renal transplant donors.
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2
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Hölttä T, Gordin D, Rahkonen O, Turanlahti M, Holmström M, Tainio J, Rönnholm K, Jalanko H. Good long-term renal graft survival and low incidence of cardiac pathology in adults after short dialysis period and renal transplantation in early childhood - a cohort study. Transpl Int 2019; 33:89-97. [PMID: 31505063 DOI: 10.1111/tri.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/28/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
Abstract
Over the past 30 years, there has been an improvement in both patient and graft survival after pediatric renal transplantation (RTX). Despite this success, these patients still carry an elevated risk for untimely death, partly through premature aging of the vasculature. The aim of this study was thus to investigate the long-term outcome of individuals with RTX in childhood, as well as to explore the cardiovascular health of these adults more than a decade later. We studied 131 individuals who had undergone a RTX between the years 1979 and 2005. Furthermore, left ventricular hypertrophy (LVH), coronary artery calcifications (CAC), and related metabolic factors were investigated in a cross-sectional study including 52 individuals as part of the initial cohort. The mortality rate (n = 131) was 12.2%. The median estimated graft survival was 17.5 years (95% CI 13.6-21.3), being significantly better in children transplanted below the age of 5 years (18.6 vs. 14.3 years, P < 0.01) compared with older ones. CAC were found in 9.8% and LVH in 13% of the patients. Those with cardiac calcifications had longer dialysis vintage and higher values of parathyroid hormone (PTH) during dialysis. Left ventricular mass correlated positively with systolic blood pressure, PTH, and phosphate measured at the time of the study.
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Affiliation(s)
- Tuula Hölttä
- Department of Pediatric Nephrology and Transplantation, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Abdominal Center Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Otto Rahkonen
- Department of Pediatric Cardiology, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
| | - Maila Turanlahti
- Department of Pediatric Cardiology, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Medical Imaging Center, HUS Helsinki University Hospital, Helsinki, Finland
| | - Juuso Tainio
- Department of Pediatric Nephrology and Transplantation, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
| | - Kai Rönnholm
- Department of Pediatric Nephrology and Transplantation, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
| | - Hannu Jalanko
- Department of Pediatric Nephrology and Transplantation, The New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland
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3
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Chatani B, Glaberson W, Nemeth Z, Tamariz L, Gonzalez IA. GCV/VCVG prophylaxis against CMV DNAemia in pediatric renal transplant patients: A systematic review and meta-analysis. Pediatr Transplant 2019; 23:e13514. [PMID: 31210393 DOI: 10.1111/petr.13514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/27/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
CMV disease continues to stand as a significant threat to the longevity of renal transplants in children. More pediatric recipients are CMV-negative with CMV-positive donor serologies resulting in a HR mismatch. The length of prophylaxis with GCV or VGCV required to optimally prevent recurrence of CMVDNAemia remains unknown. This study is a meta-analysis comparing GCV/VGCV prophylaxis regimens provided for <6 months, from 6 to <12 months, and ≥12 months after transplant in order to prevent CMVDNAemia. The search conducted involved PubMed, EMBASE, ISI Web of Science, and Cochrane Central Register from inception through December 2017. Search terms Kidney Transplantation, CMV, GCV, and VGCV provided 204 studies for abstract review. Studies excluded were those which did not itemize pediatric data separately, single case reports, and duplicate studies. Pooled analysis of five retrospective studies and one prospective study identified that there is no statistically significant difference in the incidence of CMV DNAemia when comparing <6 months of prophylaxis and >12 months of prophylaxis (23% and 15%, respectively, P = 0.23). Regardless of the length of prophylaxis, there was no statistical difference in the incidence of CMV DNAemia in the HR patients (6 to <12 months vs <6 months, P = 0.62; 6 to <12 months vs ≥12 months, P = 0.78; ≥12 months vs <6 months, P = 0.83). This study identifies no optimal length of prophylaxis for HR mismatch pediatric renal transplant patients as many develop CMV DNAemia.
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Affiliation(s)
- Brandon Chatani
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Wendy Glaberson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Zsuzsanna Nemeth
- Department of Health Informatics, University of Miami Miller School of Medicine, Miami, Florida
| | - Leonardo Tamariz
- Department of Population Health and Computation Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan A Gonzalez
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, Florida
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4
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de Souza VC, Garcia CD, Pestana JM, Stopa Martins SB, Porini Custódio LDF, Bittencourt V, Rohde R, Simões Pires I, Camargo MFD, Koch Nogueira P, Feltran LDS, Esmeraldo RDM, Souza Costa RC, Schvartsman B, Watanabe A, Cunha MFMD, Santos R, Prates LC, Belangero VMS, Palma L, Takase HM, de Andrade LGM, Benini V, Laranjo Martins SP, Abbud-Filho M, Fernandes-Charpiot I, Ramalho H, Quaresma Mendonça AC, Vasconcelos MA, Andrade Nunes C, Penido de Paula MG, Moura Diniz Ferreira Leite C, Russo ER, Facincani I, Wagner MB. Collaborative Brazilian pediatric renal transplant registry (CoBrazPed-RTx): A report from 2004 to 2018. Pediatr Transplant 2019; 23:e13463. [PMID: 31332958 DOI: 10.1111/petr.13463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 12/01/2022]
Abstract
The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death.
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Affiliation(s)
- Vandrea Carla de Souza
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul/Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Clotilde Druck Garcia
- Department of Nephrology, Organ Donation and Transplantation Program, Universidade Federal Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
| | | | | | | | - Viviane Bittencourt
- Hospital da Criança Santo Antônio-Santa Casa, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Roberta Rohde
- Hospital da Criança Santo Antônio-Santa Casa, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Izadora Simões Pires
- Hospital da Criança Santo Antônio-Santa Casa, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | | | | | | | | | - Benita Schvartsman
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina -Universidade de São Paulo, São Paulo, Brazil
| | - Andreia Watanabe
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina -Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Lilian Palma
- Universidade Estadual de Campinas, Campinas, Brazil
| | | | | | | | | | - Mario Abbud-Filho
- Hospital de Base, São José do Rio Preto, Brazil.,Instituto Urologia e Nefrologia, São José Do Rio Preto, Brazil
| | | | - Horacio Ramalho
- Hospital de Base, São José do Rio Preto, Brazil.,Instituto Urologia e Nefrologia, São José Do Rio Preto, Brazil
| | | | | | | | | | | | - Enzo Ricardo Russo
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirao Preto, Brazil
| | - Inalda Facincani
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirao Preto, Brazil
| | - Mario Bernardes Wagner
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Martinez-Mier G, Mendez-Lopez MT, Soto-Miranda E, Moreno-Ley PI, Budar-Fernandez LF, Rizo-Velazquez CG, Vega-Rojano L. Acute Rejection Is a Strong Negative Predictor of Graft Survival in Living-Donor Pediatric Renal Transplant: 10-Year Follow-Up in a Single Mexican Center. EXP CLIN TRANSPLANT 2019; 17:170-176. [PMID: 30945629 DOI: 10.6002/ect.2017.0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant is the optimal treatment for children with end-stage renal disease. Multiple factors affect patient and graft survival. We assessed determinants of long-term patient/graft survival in our center by a retrospective review of pediatric living donor (< 18 years) kidney transplants from February 2003 to December 2016. MATERIALS AND METHODS Donor and recipient demo-graphic data and immunosuppression use were gathered for analyses. Transplant outcomes included patient/graft survival, acute rejection, and 1-year estimated glomerular filtration rate. Patient/graft survival results were analyzed by Kaplan-Meier, and Cox proportional hazards regression model was used for risk factors (univariate/multivariate). P ≤ .05 was statistically significant. RESULTS Ninety-nine patients were included. Age was 13.4 ± 3.08 years, 64.6% were male, and 88.9% were on dialysis with time of 17.1 ± 12.6 months. Mean donor age was 36.6 ± 7.7 years, and most were females (63.6%). Donor estimated glomerular filtration rate was 89.4 ± 16.9 mL/min/1.73 m2. HLA match was 3.2 ± 1.05. Panel reactive antibody showed 8.6 ± 20.5%. Of total patients, 47.5% used induction, 88.9% used cyclo-sporine, and 100% used mycophenolate mofetil. Five- and 10-year patient survival rates were 93.2% and 93.2%. One-year acute rejection was 14.1%, with rate of 24.2% throughout follow-up. One-year estimated glomerular filtration rate was 76.4 ± 25.6 mL/min/1.73 m2. Five- and 10-year graft survival rates were 62.6% and 43.3%. Multivariate analysis confirmed donor age and acute rejection episodes throughout follow-up as risk factors for graft survival (P < .05). CONCLUSIONS Acute rejection and donor age are important risk factors for 10-year graft survival in living-donor pediatric kidney transplant in our program.
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Affiliation(s)
- Gustavo Martinez-Mier
- From the Research Department and the Organ Transplantation Department, UMAE Hospital Especialidades 14 "Adolfo Ruiz Cortines" IMSS, Veracruz, Mexico
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6
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The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation 2019; 102:900-931. [PMID: 29596116 DOI: 10.1097/tp.0000000000002191] [Citation(s) in RCA: 708] [Impact Index Per Article: 141.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.
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7
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Serrano OK, Bangdiwala AS, Vock DM, Chinnakotla S, Dunn TB, Finger EB, Kandaswamy R, Pruett TL, Najarian JS, Matas AJ, Chavers B. Incidence and magnitude of post-transplant cardiovascular disease after pediatric kidney transplantation: Risk factor analysis of 1058 pediatric kidney transplants at the university of Minnesota. Pediatr Transplant 2018; 22:e13283. [PMID: 30151948 DOI: 10.1111/petr.13283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND KT recipients have increased the risk of CVD. The incidence of post-transplant CVEs among pediatric recipients has not been well-characterized. PATIENTS AND METHODS Between 1963 and 2015, 884 pediatric (age: 0-17 years old) recipients received 1058 KTs at our institution. The cumulative incidence of CVEs was analyzed. Statistical models were used to estimate risk factors for developing post-transplant CVEs. RESULTS Overall median patient survival was 33 years (IQR: 18.7-47). A total of 362 CVEs occurred in 161 (18.3%) patients at a median age of 20.5 years. Arrhythmias (18%) were most common. Cumulative risk of post-transplant CVEs was 9% at 10 years, 17% at 20 years, 25% at 30 years, and 36% at 40 years. Development of post-transplant CVEs was associated with increased mortality (HR 2.25 [95% CI 1.61-3.14]); of those who developed a CVE and died, 22/51 (43.1%) died of CVD. Multivariable risk factors for post-transplant CVEs included a history of pretransplant CVD (aHR 1.92 [1.18-3.13] and graft failure (4.57 [3.13-6.67]). DISCUSSION A pretransplant history of CVD and a failed graft are significant risk factors for the development of post-transplant CVE. CVD increases the risk of post-transplant death or graft loss.
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Affiliation(s)
- Oscar K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ananta S Bangdiwala
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Srinath Chinnakotla
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ty B Dunn
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Erik B Finger
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Raja Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Timothy L Pruett
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - John S Najarian
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Blanche Chavers
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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8
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Antunes H, Parada B, Tavares-da-Silva E, Carvalho J, Bastos C, Roseiro A, Nunes P, Figueiredo A. Pediatric Renal Transplantation: Evaluation of Long-Term Outcomes and Comparison to Adult Population. Transplant Proc 2018; 50:1264-1271. [PMID: 29880345 DOI: 10.1016/j.transproceed.2018.02.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/17/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In Europe, pediatric transplantation accounts for only about 4% of all kidney transplantations performed. The aim of our work is to evaluate the evolution of pediatric renal transplantation in our department over time, but also to compare this special population with the adult one. METHODS We evaluated all pediatric renal transplantations performed in our department between January 1981 and December 2016. We performed the analysis of clinical, analytical, and surgical factors to look for predictive factors of graft loss or decrease of survival. In addition, we performed a comparative study of pediatric and adult populations and an evaluation of the evolution of pediatric renal transplantation in our department over time. RESULTS We evaluated 101 renal transplantations performed in patients younger than 18 years. Pediatric transplantations corresponded to 3.4% of all renal transplantations performed in our department. The rate of living donors was 12%. Donors of grafts for the pediatric population were significantly younger than in the adult population. The increase in donor age was associated with lower renal graft survival rates. Acute rejections were more frequent in the pediatric population. Eleven pediatric recipients (10.9%) died in the follow-up period. Renal graft survival in the pediatric population was 94.8%, 77.4%, and 66.5% at 1, 5, and 10 years, respectively. There was no significant difference in graft survival in the pediatric and adult population. The pediatric overall survival rate at 1, 5 and 10 years was 97.9%, 96.8%, and 91.9%, respectively. CONCLUSION Pediatric renal transplantation presents results identical to those identified in adults.
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Affiliation(s)
- H Antunes
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.
| | - B Parada
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - E Tavares-da-Silva
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - J Carvalho
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - C Bastos
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - A Roseiro
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - P Nunes
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - A Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
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9
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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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10
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Al Riyami MS, Al Saidi S, Al Ghaithi B, Al Maskari A, Lala S, Mohsin N, Hirshikesan L, Al Kalbani N. Pediatric Renal Transplantation in Oman: A Single-center Experience. Oman Med J 2018; 33:7-14. [PMID: 29467993 DOI: 10.5001/omj.2018.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. Results During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Conclusions Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival.
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Affiliation(s)
- Mohamed S Al Riyami
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sulaiman Al Saidi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Badria Al Ghaithi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Anisa Al Maskari
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sadiq Lala
- Urology Unit, Department of Surgery, Royal Hospital, Muscat, Oman
| | - Nabil Mohsin
- Department of Medicine, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Lekha Hirshikesan
- Department of Nephrology Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Naifain Al Kalbani
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
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11
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Papachristou F, Stabouli S, Printza N, Mitsioni A, Stefanidis C, Miserlis G, Dotis J, Kapogiannis A, Georgaki-Angelaki H, Gkogka C, Kollios K, Papanikolaou V. Long-term outcome of pediatric kidney transplantation: A single-center experience from Greece. Pediatr Transplant 2016; 20:500-6. [PMID: 27029484 DOI: 10.1111/petr.12700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/29/2022]
Abstract
Pediatric kidney Tx has critically altered the outcome in ESRD pediatric patients. The aims of this study were to determine long-term graft and patient survival in a homogeneous ethnic population. We reviewed the medical charts of pediatric kidney Tx performed between 1990 and 2012 in Greece. Seventy-five kidney Txs were performed from LRD and 62 from DD. The 10- and 20-yr graft survival was higher in LRD Tx compared with DD Tx. Both patient and graft survival at 10 and 20 yr after Tx were similar in LRD Tx from grandparents compared with parents (92.9% vs. 93.4% 20-yr patient survival, 71.4% vs. 78.7% and 57.1% vs. 72.1%, 10- and 20-yr graft survival, respectively). However, there was a decreasing tendency in LRD Tx rates in period 2001-2012 compared with period 1990-2000 (47.1% vs. 62.7%). Risk factors for poor five-yr graft survival were DD Tx, and induction treatment with ALG compared with basiliximab, but their effect attenuated at 10 yr after Tx. In conclusion, Tx from LRD may offer efficient survival outcomes irrespective of donor age, suggesting that even older LRD could be an excellent option for the 1st kidney Tx in children and adolescents.
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Affiliation(s)
- Fotios Papachristou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Stabouli
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoleta Printza
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andromachi Mitsioni
- Department of Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Grigorios Miserlis
- Division of Transplantation, Department of Surgery, Medical School, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - John Dotis
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Chrysa Gkogka
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kollios
- 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Papanikolaou
- Division of Transplantation, Department of Surgery, Medical School, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
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12
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Dursun I, Yel S, Unsur E. Dynamics of circulating microparticles in chronic kidney disease and transplantation: Is it really reliable marker? World J Transplant 2015; 5:267-275. [PMID: 26722654 PMCID: PMC4689937 DOI: 10.5500/wjt.v5.i4.267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/21/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
The deterioration of endothelial structure plays a very important role in the development of vascular diseases. It is believed that endothelial dysfunction starts in the early stage of kidney disease and is a risk factor of an unfavorable cardiovascular prognosis. Because a direct assessment of biological states in endothelial cells is not applicable, the measurement of endothelial microparticles (EMPs) detached from endothelium during activation or apoptosis is thought to be a marker of early vascular disease and endothelial dysfunction in children with chronic kidney disease (CKD). Few studies have shown increased circulating EMPs and its relationship with cardiovascular risk factors in patients with CKD. MPs contain membrane proteins and cytosolic material derived from the cell from which they originate. EMPs having CD144, CD 146, CD31+/CD41-, CD51 and CD105 may be used to evaluate the vascular endothelial cell damage and determine asymptomatic patients who might be at higher risk of developing cardiovascular disease in CKD and renal transplant.
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Bobanga ID, Vogt BA, Woodside KJ, Cote DR, Dell KM, Cunningham RJ, Noon KA, Barksdale EM, Humphreville VR, Sanchez EQ, Schulak JA. Outcome differences between young children and adolescents undergoing kidney transplantation. J Pediatr Surg 2015; 50:996-9. [PMID: 25805006 DOI: 10.1016/j.jpedsurg.2015.03.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Although graft loss remains the biggest challenge for all pediatric kidney transplant (KT) recipients, unique challenges exist within different age groups. We aim to evaluate the different characteristics and graft survival outcomes of young children and adolescents undergoing KT. METHODS Children who underwent isolated KT between 2000 and 2013 at our institution were included in this retrospective analysis. Patient characteristics and outcomes were compared using student's t-test, chi-square test, Kaplan-Meier curve and Cox proportional hazards model. RESULTS Of 73 children who underwent KT, 31 were <12 (young children), and 42 were ≥ 12 years old (adolescents). Overall patient survival was 100%. The younger group had superior 5-year (100% vs. 75.5%) and 10-year (94.4% vs. 43.8%) graft survival (p=0.008). Factors predictive of poor graft survival on multivariate analysis were older age at transplantation (HR 1.2, CI 1-1.4, p=0.047), female gender (HR 9.0, CI 1.9-43, p=0.006), and acute rejection episodes (HR 13, CI 2-90, p=0.008). The most common causes of graft loss were acute and chronic rejection episodes and immunosuppression nonadherence. CONCLUSION Adolescents undergoing KT have inferior graft survival compared to younger children. In adjusted modeling, children with older age, female gender, and acute rejection episodes have inferior graft survival.
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Affiliation(s)
- Iuliana D Bobanga
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Beth A Vogt
- Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Kenneth J Woodside
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
| | - Devan R Cote
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Katherine M Dell
- Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Robert J Cunningham
- Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Kelly A Noon
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Edward M Barksdale
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Vanessa R Humphreville
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Edmund Q Sanchez
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - James A Schulak
- Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
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14
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Hattori M, Sako M, Kaneko T, Ashida A, Matsunaga A, Igarashi T, Itami N, Ohta T, Gotoh Y, Satomura K, Honda M, Igarashi T. End-stage renal disease in Japanese children: a nationwide survey during 2006-2011. Clin Exp Nephrol 2015; 19:933-8. [PMID: 25595442 DOI: 10.1007/s10157-014-1077-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/17/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) in children is considered a rare, but serious condition. Epidemiological and demographic information on pediatric ESRD patients around the world is important to better understand this disease and to improve patient care. The Japanese Society for Pediatric Nephrology (JSPN) reported epidemiological and demographic data in 1998. Since then, however, there has been no nationwide survey on Japanese children with ESRD. METHODS The JSPN conducted a cross-sectional nationwide survey in 2012 to update information on the incidence, primary renal disease, initial treatment modalities, and survival in pediatric Japanese patients with ESRD aged less than 20 years during the period 2006-2011. RESULTS The average incidence of ESRD was 4.0 per million age-related population. Congenital anomalies of the kidney and urinary tract were the most common cause of ESRD, present in 39.8 % of these patients. In addition, 12.2 % had focal segmental glomerulosclerosis and 5.9 % had glomerulonephritis. Initial treatment modalities in patients who commenced renal replacement therapy (RRT) consisted of peritoneal dialysis, hemodialysis, and pre-emptive transplantation (Tx) in 61.7, 16.0, and 22.3 %, respectively. The Japanese RRT mortality rate was 18.2 deaths per 1000 person-years of observation. CONCLUSION The incidence of ESRD is lower in Japanese children than in children of other high-income countries. Since 1998, notably, there has been a marked increase in pre-emptive Tx as an initial treatment modality for Japanese children with ESRD.
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Affiliation(s)
- Motoshi Hattori
- Department of Pediatric Nephrology, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Mayumi Sako
- Division for Clinical Trials, Department of Development Strategy, Center for Social and Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuji Kaneko
- Division of Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | | | - Tohru Igarashi
- Department of Pediatrics, Nippon Medical University, Tokyo, Japan
| | | | - Toshiyuki Ohta
- Department of Pediatric Nephrology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yoshimitsu Gotoh
- Department of Pediatrics, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | - Kenichi Satomura
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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