Graft nephrectomy in children

Phillips, Benedict L.; Callaghan, Chris

doi:10.1007/s00467-017-3697-1

Cited by 7 publications

(4 citation statements)

References 50 publications

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“…Recipients with painful grafts / graft intolerance syndrome are likely to have ongoing resistant rejection which could lead to sensitization. Graft nephrectomy has been proposed to be potentially beneficial in patients with graft intolerance syndrome 22,23 although this is yet to be proven 24 . In 2 patients, the indication for nephrectomy was severe antibody‐mediated rejection.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns and influence of allograft nephrectomy in pediatric kidney re‐transplantation: A pediatric nephrology research consortium study

Verghese

Luckritz

Moudgil

et al. 2021

Pediatric Transplantation

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Introduction There are no guidelines regarding management of failed pediatric renal transplants. Materials & Methods We performed a first of its kind multicenter study assessing prevalence of transplant nephrectomy, patient characteristics, and outcomes in pediatric renal transplant recipients with graft failure from January 1, 2006, to December 31, 2016. Results Fourteen centers contributed data on 186 pediatric recipients with failed transplants. The 76 recipients that underwent transplant nephrectomy were not significantly different from the 110 without nephrectomy in donor or recipient demographics. Fifty‐three percent of graft nephrectomies were within a year of transplant. Graft tenderness prompted transplant nephrectomy in 91% (P < .001). Patients that underwent nephrectomy were more likely to have a prior diagnosis of rejection within 3 months (43% vs 29%; P = .04). Nephrectomy of allografts did not affect time to re‐listing, donor source at re‐transplant but significantly decreased time to (P = .009) and incidence (P = .0002) of complete cessation of immunosuppression post‐graft failure. Following transplant nephrectomy, recipients were significantly more likely to have rejection after re‐transplant (18% vs 7%; P = .03) and multiple rejections in first year after re‐transplant (7% vs 1%; P = .03). Conclusions Practices pertaining to failed renal allografts are inconsistent—40% of failed pediatric renal allografts underwent nephrectomy. Graft tenderness frequently prompted transplant nephrectomy. There is no apparent benefit to graft nephrectomy related to sensitization; but timing / frequency of immunosuppression withdrawal is significantly different with slightly increased risk for rejection following re‐transplant.

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Section: Discussionmentioning

confidence: 99%

Practice patterns and influence of allograft nephrectomy in pediatric kidney re‐transplantation: A pediatric nephrology research consortium study

Verghese

Luckritz

Moudgil

et al. 2021

Pediatric Transplantation

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“…It is well-established that GN is indicated in cases of vascular thrombosis, hyperacute rejection, and therapy resistant malignancy (183)(184)(185)(186)(187). Relative indications include severe graft pyelonephritis, the wish of withdrawal of immunosuppressants and symptoms of the intolerance syndrome (185,188,189). The removal of an asymptomatic non-functioning graft remains controversial.…”

Section: Transplantectomymentioning

confidence: 99%

“…This difference might be caused by the higher rates of acute rejection in children, which was thought to be caused by a more vigorous immune response in children (192). In both adults and children, recipients were most likely to have GN when graft failure occurred in the 1st year after transplantation (185)(186)(187)191).…”

Section: Transplantectomymentioning

confidence: 99%

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

et al. 2022

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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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“…Indications for graft nephrectomy are well established but it should be appreciated that there is a mortality rate of up to 1.5% at 30 days [19, 20]. There is evidence that graft nephrectomy is associated with a risk of sensitisation to both Human Leukocyte Antigens (HLA) classes I and II [21].…”

Section: Introductionmentioning

confidence: 99%

Management of chronic renal allograft dysfunction and when to re-transplant

Baker

Marks

2018

Pediatr Nephrol

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Despite the advances in renal transplantation over the last decades, chronic allograft dysfunction remains the largest concern for patients, their families, clinicians and other members of the multi-disciplinary team. Although we have made progress in improving patient and renal allograft survival within the first year after transplantation, the rate of transplant failure with requirement for commencement of dialysis or re-transplantation has essentially remained unchanged. It is important that paediatric and adult nephrologists and transplant surgeons, not only manage their patients and their renal transplants but provide the best chronic kidney disease management during the time of decline of renal allograft function. The gold standard for patients with Stage V chronic kidney disease is to have pre-emptive living donor transplants, where possible and the same is true for healthy renal transplant recipients with declining renal allograft function. The consideration for children and young people as they embark on their end-stage kidney disease journey is the risk-benefit profile of giving the best immunologically matched and good quality renal allografts as they may require multiple renal transplantation operations during their lifetime.

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Graft nephrectomy in children

Cited by 7 publications

References 50 publications

Practice patterns and influence of allograft nephrectomy in pediatric kidney re‐transplantation: A pediatric nephrology research consortium study

Practice patterns and influence of allograft nephrectomy in pediatric kidney re‐transplantation: A pediatric nephrology research consortium study

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

Management of chronic renal allograft dysfunction and when to re-transplant

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