Abstract:Chronic allograft nephropathy (CAN) is now the leading cause of renal transplant loss in paediatric transplant recipients. Despite improvements in immunosuppression, which have significantly reduced the incidence of acute rejection, the rates of chronic kidney loss have remained unchanged in paediatric transplant patients over the last 20 years. Chronic allograft nephropathy is a pathological diagnosis of which the key features are tubular atrophy and interstitial fibrosis. More consistent definitions and grad… Show more
“…In our present report, four surveillance biopsies demonstrated histologic evidence for CAN but only one case was associated with SCR. This finding supports the concept recently proposed by Alexander et al that CAN may arise from a variety of immune and non‐immune injuries (17). The development of CAN from early cases of SCR will also require further investigation by performing multiple surveillance biopsies in these patients over several years.…”
A high incidence of SCR was found on surveillance biopsies at three months post-transplant and could not be predicted by age, gender, race, donor source, or serum creatinine. The occurrence of SCR declined significantly by increasing the dose of MMF, but resulted in an increase in BK viremia. We conclude that surveillance biopsies provide valuable information in the management of pediatric renal transplant recipients. Increasing immunosuppression to avoid SCR should be weighed against the risk for infection.
“…In our present report, four surveillance biopsies demonstrated histologic evidence for CAN but only one case was associated with SCR. This finding supports the concept recently proposed by Alexander et al that CAN may arise from a variety of immune and non‐immune injuries (17). The development of CAN from early cases of SCR will also require further investigation by performing multiple surveillance biopsies in these patients over several years.…”
A high incidence of SCR was found on surveillance biopsies at three months post-transplant and could not be predicted by age, gender, race, donor source, or serum creatinine. The occurrence of SCR declined significantly by increasing the dose of MMF, but resulted in an increase in BK viremia. We conclude that surveillance biopsies provide valuable information in the management of pediatric renal transplant recipients. Increasing immunosuppression to avoid SCR should be weighed against the risk for infection.
“…Italics indicate potential precipitating factors for CAN associated with the areas they specifically target. Reprinted with permission from [51]Fig. 2 a Renal allograft biopsy ( silver staining ) showing features of transplant glomerulopathy with evidence of “double contours” in capillary loops, mesangial proliferation and matrix expansion and basement membrane thickening.…”
Section: Histopathologymentioning
confidence: 99%
“…Italics indicate potential precipitating factors for CAN associated with the areas they specifically target. Reprinted with permission from [51]…”
Section: Histopathologymentioning
confidence: 99%
“…Other new agents include the new CTLA4-Ig antibody belatacept, which has been used successfully in place of CNIs in adult studies of kidney transplantation [51] and the Janus kinase (JAK) inhibitors.…”
Chronic allograft nephropathy (CAN) is the leading cause of renal allograft loss in paediatric renal transplant recipients. CAN is the result of immunological and nonimmunological injury, including acute rejection episodes, hypoperfusion, ischaemia reperfusion, calcineurin toxicity, infection and recurrent disease. The development of CAN is often insidious and may be preceded by subclinical rejection in a well-functioning allograft. Classification of CAN is histological using the Banff classification of renal allograft pathology with classic findings of interstitial fibrosis, tubular atrophy, glomerulosclerosis, fibrointimal hyperplasia and arteriolar hyalinosis. Although improvement in immunosuppression has led to greater 1-year graft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectious complications remain a problem. Protocol biopsy monitoring is not current practice in paediatric transplantation for CAN monitoring but may have a place if new treatment options become available. Newer immunosuppression regimens, closer monitoring of the renal allograft and management of subclinical rejection may lead to reduced immune injury leading to CAN in the paediatric population but must be weighed against the risk of increased immunosuppression and calcineurin inhibitor nephrotoxicity.
“…Se trasplantan niños que por su peso y tamaño, así como por su gran labilidad, necesitan unos cuidados minuciosos y específi cos por parte de personal experto y entrenado en su manejo. A pesar de las mejoras en el tratamiento inmunosupresor, que han reducido la incidencia de rechazo agudo, las tasas de pérdida renal crónica se han mantenido elevadas en los pacientes pediátricos en los últimos 20 años 1 …”
There are numerous causes of therapeutic noncompliance in paediatric patients with a renal transplant.Cumplimiento del tratamiento en el trasplante renal pediátrico
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