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Redhead ECG, Paessler A, Arslan Z, Patel P, Minhas K, Forman C, Hollis P, Lava S, Ionescu F, Manuel D, Ray S, Kessaris N, Giardini A, Ratnamma V, Dobby N, Tullus K, Simmonds J, Stojanovic J. Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions. Pediatr Nephrol 2024; 39:521-530. [PMID: 37658875 PMCID: PMC10728245 DOI: 10.1007/s00467-023-06123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention. METHODS All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention. RESULTS One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy. CONCLUSIONS Our study reports improvement in cardiac outcomes after endovascular + / - surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. A higher resolution version of the Graphical abstract is available as Supplementary information. SUPPLEMENTARY INFORMATION
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Affiliation(s)
- Emily C G Redhead
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Zainab Arslan
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kishore Minhas
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Forman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Paolo Hollis
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Sebastiano Lava
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Florin Ionescu
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Devi Manuel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Samiran Ray
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nicos Kessaris
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Alessandro Giardini
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Vineetha Ratnamma
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nadine Dobby
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kjell Tullus
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jelena Stojanovic
- University College London Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
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Paessler A, Cortes-Cerisuelo M, Jassem W, Vilca-Melendez H, Deep A, Jain V, Pool A, Grunewald S, Kessaris N, Stojanovic J. Transplantation in paediatric patients with MMA requires multidisciplinary approach for achievement of good clinical outcomes. Pediatr Nephrol 2023:10.1007/s00467-023-05906-0. [PMID: 36840752 PMCID: PMC10393894 DOI: 10.1007/s00467-023-05906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND As modern medicine is advancing, younger, small, and more complex children are becoming multi-organ transplant candidates. This brings up new challenges in all aspects of their care. METHODS We describe the first report of a small child receiving a simultaneous liver and kidney transplant and abdominal rectus sheath fascia transplant on the background of Williams syndrome and methylmalonic acidaemia. At the time of transplantation, the child was 3 years old, weighed 14.0 kg, had chronic kidney disease stage V, and had not yet started any other form of kidney replacement therapy. RESULTS There were many anaesthetic, medical, metabolic, and surgical challenges to consider in this case. A long general anaesthetic time increased the risk of cardiac complications and metabolic decompensation. Additionally, the small size of the patient and the organ size mis-match meant that primary abdominal closure was not possible. The patient's recovery was further complicated by sepsis, transient CNI toxicity, and de novo DSAs. CONCLUSIONS Through a multidisciplinary approach between 9 specialties in 4 hospitals across England and Wales, and detailed pre-operative planning, a good outcome was achieved for this child. An hour by hour management protocol was drafted to facilitate transplant and included five domains: 1. management at the time of organ offer; 2. before the admission; 3. at admission and before theatre time; 4. intra-operative management; and 5. post-operative management in the first 24 h. Importantly, gaining a clear and in depth understanding of the metabolic state of the patient pre- and peri-operatively was crucial in avoiding metabolic decompensation. Furthermore, an abdominal rectus sheath fascia transplant was required to achieve abdominal closure, which to our knowledge, had never been done before for this indication. Using our experience of this complex case, as well as our experience in transplanting other children with MMA, and through a literature review, we propose a new perioperative management pathway for this complex cohort of transplant recipients.
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Affiliation(s)
- Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Wayel Jassem
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Akash Deep
- King's College Hospital NHS Foundation Trust, London, UK
| | - Vandana Jain
- King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Pool
- King's College Hospital NHS Foundation Trust, London, UK
| | - Stephanie Grunewald
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | | | - Jelena Stojanovic
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK.
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Paessler A, Boyle S, Marks S, Kessaris N, Stojanovic J. Psychological Concerns of Children Undergoing Kidney Transplantation During the Pandemic: Single-centre Experience. BMJ Paediatr Open 2021; 5:e001174. [PMID: 34423141 PMCID: PMC8323380 DOI: 10.1136/bmjpo-2021-001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 11/03/2022] Open
Abstract
Many paediatric kidney transplant programmes were closed during the COVID-19 pandemic, and due to the vulnerable nature of patients with end-stage kidney disease (ESKD), there were new concerns once these programmes reopened. We surveyed children and families who received a kidney transplant during the pandemic. We found that half of the participants felt scared and/or anxious about receiving a kidney transplant during the pandemic, and 2/8 participants were worried about catching COVID-19 during their recovery. While detailed counselling and additional safety precautions contributed to a good experience, patients and parents still demonstrated fear towards transplantation.
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Affiliation(s)
- Alicia Paessler
- University College London Great Ormond Street Institute of Child Health Library, London, UK.,Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Sheila Boyle
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Stephen Marks
- University College London Great Ormond Street Institute of Child Health Library, London, UK.,Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Nicos Kessaris
- Transplantation, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Jelena Stojanovic
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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