Kidney Transplantation in Children and Adolescents

Giessing, Markus; Müller, Dominik N.; Winkelmann, B.; Roigas, Jan; Loening, Stefan A.

doi:10.1016/j.transproceed.2007.07.011

Cited by 32 publications

(17 citation statements)

References 44 publications

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“…These improvements are probably due to significant advances in immunosuppression, 4,9,18-20 surgical technique, 4,18,21 alloantibody detection and desensitization strategies, 4,21 and infectious disease prevention and treatment. 4,18 Finally, other latent factors that have improved over time, such as crossmatch technology and interdisciplinary collaboration in posttransplant care, may also contribute to the temporal improvements in outcomes.…”

Section: Discussionmentioning

confidence: 99%

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. WHAT THIS STUDY ADDS:Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. abstract OBJECTIVE: To investigate changes in pediatric kidney transplant outcomes over time and potential variations in these changes between the early and late posttransplant periods and across subgroups based on recipient, donor, and transplant characteristics. METHODS:Using multiple logistic regression and multivariable Cox models, graft and patient outcomes were analyzed in 17 446 pediatric kidneyonly transplants performed in the United States between 1987 and 2012.RESULTS: Ten-year patient and graft survival rates were 90.5% and 60.2%, respectively, after transplantation in 2001, compared with 77.6% and 46.8% after transplantation in 1987. Primary nonfunction and delayed graft function occurred in 3.3% and 5.3%, respectively, of transplants performed in 2011, compared with 15.4% and 19.7% of those performed in 1987. Adjusted for recipient, donor, and transplant characteristics, these improvements corresponded to a 5% decreased hazard of graft loss, 5% decreased hazard of death, 10% decreased odds of primary nonfunction, and 5% decreased odds of delayed graft function with each more recent year of transplantation. Graft survival improvements were lower in adolescent and female recipients, those receiving pretransplant dialysis, and those with focal segmental glomerulosclerosis. Patient survival improvements were higher in those with elevated peak panel reactive antibody. Both patient and graft survival improvements were most pronounced in the first posttransplant year. CONCLUSIONS:Outcomes after pediatric kidney transplantation have improved dramatically over time for all recipient subgroups, especially for highly sensitized recipients. Most improvement in graft and patient survival has come in the first year after transplantation, highlighting the need for continued progress in long-term outcomes. The field of pediatric KT has evolved over the past 25 years, including changes in immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. 4 However, the relationship between these changes and post-KT outcomes remains unclear, both in terms of which patient phenotypes have been affected and when any changes in outcomes have occurred (ie, early versus late post-KT).The objective of this study was to examine changes in pediatric KToutcomes over the last 25 years. In particular, our work sought to assess trends in graft survival, rates of primary nonfunct...

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Section: Discussionmentioning

confidence: 99%

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

et al. 2014

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“…Renal transplantation is the optimal treatment for end‐stage renal failure in adults and children . However, developed countries face organ shortages due to increased kidney transplantation rates with a trend to earlier transplantation, organ donation refusal by donors or donors’ families, and the inadequacy of procured organs (immunological incompatibility, infectious contraindication, etc.).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation

Michelet

Brasher²,

Marsac

et al. 2017

Pediatric Anesthesia

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“…Furthermore, a lower survival rate for lower weight children was reported by Arnon et al [3] , and according to other studies, this poorer survival results from higher risks of perioperative vascular complications, bile duct complications and infections [4,6,7] . In pediatric kidney transplantation, the ideal body weight for a recipient has also been found to be greater than 10 kg [8] . Most of the previous reports regarding pediatric organ transplantation have primarily evaluated the outcomes in terms of the morbidity and mortality of the procedure in question [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

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AIM:To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation. METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation betweenJune 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients' ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively. RESULTS:The general medical conditions of the G1 Retrospective StudyLiving donor liver transplantation with body-weight more or less than 10 kilograms patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z -scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar. CONCLUSION:Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg. Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.Yang SC, Huang CJ, Chen CL, Wang CH,...

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Kidney Transplantation in Children and Adolescents

Cited by 32 publications

References 44 publications

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation

Living donor liver transplantation with body-weight more or less than 10 kilograms

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