Improved Outcomes of Kidney Transplantation in Infants (Age &lt; 2 years)

Chavers, Blanche M.; Rheault, Michelle N.; Matas, Arthur J.; Jackson, Scott; Cook, Marie; Nevins, Thomas E.; Najarían, John S.; Chinnakotla, Srinath

doi:10.1097/tp.0000000000001929

Cited by 19 publications

(32 citation statements)

References 38 publications

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Section: Discussionsupporting

confidence: 86%

“…The use of our protocol has resulted in both patient and graft survival that compare favorably with recently published studies . In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%‐10% reported in prior studies . Due to multiple factors, ranging from cold ischemia time, hypotension, and donor age, DGF is a significant risk factor for the development of both acute rejection and subsequent graft loss .…”

Section: Discussionsupporting

confidence: 82%

“…10,[23][24][25][26] In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%-10% reported in prior studies. 10,23 Due to multiple factors, ranging from cold ischemia time, hypotension, and donor age, DGF is a significant risk factor for the development of both acute rejection and subsequent graft loss. 27 In total, six patients in our study developed evidence of ACR and nine with chronic rejection, none of whom had any prior episodes of delayed graft function or acute rejection episodes.…”

Section: Discussioncontrasting

confidence: 42%

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Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Lee

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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Kidney transplantation remains the treatment of choice for children with ESRD. Optimal perioperative management is critical in small recipients of ASK to assure adequate graft perfusion. We present a single‐center experience outlining management for patients weighing <20 kg who underwent primary renal transplantation with ASKs between 2007 and 2016. Sixty‐three patients met study criteria and underwent 34 living‐related, six living‐unrelated, and 23 deceased donor kidney transplants. Median age and weight at transplant were 25 months (IQR 18‐37 months; range 11 months‐6 years) and 11.0 kg (IQR 9.2‐14.5 kg; range 7.1‐19.5 kg). Eighty‐nine percent of patients required vasoactive agents intra‐operatively, with twenty patients requiring prolonged vasoactive agents post‐operatively. Intra‐operatively, patients received 51.9 mL/kg of crystalloid, 27.3 mL/kg of 5% albumin, and 13.6 mL/kg of packed red blood cells. Most (93.7%) patients were extubated on POD#0. Weights peaked on post‐operative days three through five. Over a median follow‐up of 49 months (IQR 31‐86 months; range 0‐130 months), four grafts were lost, two due to thrombosis and two secondary to chronic rejection. There was one patient death six months post‐transplant due to causes unrelated to transplantation. Graft survival at 1, 5, and 10 years was 98.4%, 96.6%, and 84.2%, respectively. Of surviving allografts, the median 1, 5, and 10 years post‐transplant eGFR was 122.9, 90.0, and 59.2 mL/min/1.73 m2 as determined by the 2009 Schwartz formula. Renal transplantation in small children using ASKs requires meticulous perioperative management including adequate fluid resuscitation and judicious use of pressors to assure adequate graft perfusion. The use of ASKs from living or deceased donors results in satisfactory short and long‐term outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 42%

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Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Lee

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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“…Unlike adult renal transplantation, the etiologies of pediatric ESRD are more commonly due to CAKUT, lower urinary tract dysfunction (neurogenic bladder, reflux, or posterior urethral valves), hereditary nephropathies, and glomerulonephritis . Patient survival rates within the first year of transplant have improved in recent years due to advancements in immunosuppression, surgical technique, organ allocation policies, and rates of living donor transplantation . Consequently, recent studies have also shown that compared to long‐term dialysis, early renal transplantation for children with ESRD may offer good mental and physical quality of life .…”

Section: Introductionmentioning

confidence: 99%

Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant

Chua

Kim

Gnech

et al. 2018

Pediatric Transplantation

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Our study aims to assess the clinical implication of RAV/rBSA ratio in PRT as a predictor for attained renal function at 1 year post‐transplantation and its association with surgical complications. A retrospective cohort was performed for PRT cases from January 2000 to December 2015 in our institution. Extracted clinical information includes the recipient's demographics, donor type, renal allograft characteristics, arterial, venous and ureteral anastomoses, vascular anastomosis time while kidney off ice, overall operative time, and estimated blood loss. The RAV/rBSA was extrapolated and assessed for its association with renal graft function attained in 1 year post‐transplantation and surgical complications within 30‐day post‐transplantation. A total of 324 PRTs cases were analyzed. The cohort consisted of 187 (52.4%) male and 137 (42.3%) female recipients, with 152 (46.9%) living donor and 172 (53.1%) deceased donor renal transplants, and an overall median age of 155.26 months (IQR 76.70‐186.98) at time of renal transplantation. The receiver operating characteristic identified that a RAV/rBSA ratio of 135 was the optimal cutoff in determining the renal graft function outcome. Univariate and multivariate analyses revealed the relative OR for RAV/rBSA ≥ 135 ratio in predicting an eGFR ≥ 90 attained within 1 year post‐transplant was highest among younger pediatric recipients (<142.5 months) of deceased kidney donors (OR = 11.143, 95% CI = 3.156‐39.34). Conversely, Kaplan‐Meier analysis revealed that RAV/rBSA ratio ≥ 135 is associated with lower odds of having eGFR <60 (OR = 0.417, 95% CI = 0.203‐0.856). The RAV/rBSA ratio was not associated nor predictive of transplant‐related surgical complications. Our study determined that the RAV/rBSA ratio is predictive of renal graft function at 1‐year PRT, but not associated with any increased surgical complications.

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“…Early transplant is recommended to avoid cardiovascular morbidity and infection risk associated with long-term dialysis [51-53]. Size at the time of transplant varies with some centers transplanting infants as small as 5 kg, but most providers aim for transplant once the child is > 10 kg.…”

Section: Approach To Fetal and Neonatal Therapy For Epramentioning

confidence: 99%

Amnioinfusions to Treat Early Onset Anhydramnios Caused by Renal Anomalies: Background and Rationale for the Renal Anhydramnios Fetal Therapy Trial

et al. 2019

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Anhydramnios caused by early anuria is thought to be universally fatal due to pulmonary hypoplasia. Bilateral renal agenesis and early fetal renal failure leading to anhydramnios constitute early pregnancy renal anhydramnios (EPRA). There have been successful reports of amnioinfusions to promote lung growth in the setting of EPRA. Some of these successfully treated EPRA fetuses have survived the neonatal period, undergone successful dialysis, and subsequently received a kidney transplant. Conversely, there are no reports of untreated EPRA survivors. This early success of amnioinfusions to treat EPRA justifies a rigorous prospective trial. The objective of this study is to provide a review of what is known about fetal therapy for EPRA and describe the Renal Anhydramnios Fetal Therapy trial. We review the epidemiology, pathophysiology, and genetics of EPRA. Furthermore, we have performed systematic review of case reports of treated EPRA. We describe the ethical framework, logistical challenges, and rationale for the current single center (NCT03101891) and planned multicenter trial.

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Improved Outcomes of Kidney Transplantation in Infants (Age < 2 years)

Abstract: Infants deserve earlier consideration for KTx. Length of initial hospital stay and patient and graft survival rates after KTx have improved in infants since 1984.

Cited by 19 publications

References 38 publications

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant

Amnioinfusions to Treat Early Onset Anhydramnios Caused by Renal Anomalies: Background and Rationale for the Renal Anhydramnios Fetal Therapy Trial

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