Kidney transplantation in children with CAKUT and non‐CAKUT causes of chronic kidney disease: Do they have the same outcomes?

Monteverde, Marta Lidia; Paz, Marcos; Ibañez, Juan; Chaparro, Alicia; Solernou, Verónica; Sager, Cristian; Tessi, Catalina; Locane, Fabrizio

doi:10.1111/petr.13763

Cited by 11 publications

(8 citation statements)

References 40 publications

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“…Our data demonstrate a substantial benefit afforded by living donor Tx in children compared to DD Tx (which had the poorest graft survival). Other predictors of graft loss found in our study are all previously well-established factors and included pre-Tx hypoalbuminemia, 7 need for pre-Tx dialysis, 8 younger recipient age (in the first post-Tx year), 9 black ethnicity, 10 female recipient sex, 3 FSGS as a cause of CKD 11 and number of HLA mismatches. 12 It is therefore heartening to note that there has been a progressive increase in the number of LURD Tx across the US over the years and that each OPTN region has centers that are accepting LURD for pediatric patients.…”

Section: Discussionsupporting

confidence: 57%

Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network database analysis

Butani

Tancredi

2022

Pediatric Transplantation

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Background There are conflicting data on long‐term outcomes of pediatric LURD renal Txs compared to Txs of kidneys from other donor sources. Methods An analysis of the OPTN database was conducted in children (<18 years) who had received their 1st kidney‐only Tx between January 1, 2000, and September 30, 2021. The primary outcome measure was time to graft failure or death. Cox event history regression model for time to primary outcome, categorized by donor source and adjusting for confounders was performed. Results Of the 12 089 subjects, 327 (2.7%) received kidneys from LURDs, 4349 (36%) from LRDs and 7413 (61%) from DD. One year graft failure rate was 3.56%. On regression analyses, compared to LRD kidney recipients, LURD recipients had comparable graft survival (graft failure AHR 1.15, 95th percentile confidence interval 0.87–1.51; p .31) and DD recipients had lower graft survival (graft failure hazard ratio 1.26, 95th percentile confidence interval 1.10–1.43; p < .001). When using living unrelated kidney recipients as the reference group, DD kidney recipients had comparable graft survival, with a wide confidence interval (hazard ratio for graft failure 1.09; 0.83–1.43, p .53). Conclusions Pediatric LURD kidney recipients have comparable graft survival to LRD kidney recipients; DD kidney recipients had the poorest survival. Our study, the largest to date, should encourage centers to embrace non‐commercial living‐unrelated transplantation as a viable option for children, preferable to DD kidneys.

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Section: Discussionsupporting

confidence: 57%

Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network database analysis

Butani

Tancredi

2022

Pediatric Transplantation

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“…Post-transplant complications apart from the expected higher rate of recurrent glomerulonephritis also occur similarly in both groups. We noted the absence of UTI increase in nRDs patients, which included subjects with CAKUT syndrome (normally exposed to increase UTI risk) [27]. Exploring this finding, we identified specific attention in this subgroup to antibiotic prophylaxis (which was generally prolonged to up to 1 week) and to a rapidly ureteral catheter/double J ureteral stent removal to prevent colonization.…”

Section: Discussionmentioning

confidence: 90%

Clinical outcomes and temporal trends of immunological and non-immunological rare diseases in adult kidney transplant

et al. 2021

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Background Rare diseases (RDs) encompass many difficult-to-treat conditions with different characteristics often associated with end-stage renal disease (ESRD). However, data about transplant outcomes in adult patients are still lacking and limited to case reports/case series without differentiation between immunological/non-immunological RDs. Methods Retrospective analysis among all adult kidney transplanted patients (KTs) with RDs (RDsKT group) performed in our high-volume transplantation center between 2005 and 2016. RDs were classified according to the Orphanet code system differentiating between immunological and non-immunological diseases, also comparing clinical outcomes and temporal trends to a control population without RDs (nRDsKT). Results Among 1381 KTs, 350 patients (25.3%) were affected by RDs (RDsKTs). During a f/up > 5 years [median 7.9 years (4.8–11.1)], kidney function and graft/patient survival did not differ from nRDsKTs. Considering all post-transplant complications, RDsKTs (including, by definition, patients with primary glomerulopathy except on IgA nephropathy) have more recurrent and de-novo glomerulonephritis (14.6% vs. 9.6% in nRDsKTs; p = 0.05), similar rates of de-novo cancers, post-transplant diabetes, dysmetabolism, hematologic disorders, urologic/vascular problems, and lower infectious episodes than nRDsKTs (63.7% vs 72.7%; p = 0.013). Additional stratification for immunological and non-immunological RDsKTs or transplantation periods (before/after 2010) showed no differences or temporal trends between groups. Conclusions Kidney transplant centers are deeply involved in RDs management. Despite their high-complex profile, both immunological and non-immunological RDsKTs experienced favorable patients’ and graft survival.

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“…Congenital Abnormalities of kidney and urinary tract (CAKUT) were defined as an alteration in the size or number of one or more kidneys and/or urinary tract disease present from birth, including primary vesicoureteral reflux, renal hypoplasia dysplasia, obstructive uropathy, or neurogenic bladder 7 …”

Section: Methodsmentioning

confidence: 99%

“…It may also affect other organs, such as the intestine, central nervous system, pancreas, heart, and liver 3,4 . In Argentina, this endemic disease is the main cause of acute kidney injury in children and the second most common cause of end‐stage renal disease (ESRD), after congenital abnormalities of the kidney and urinary tract (CAKUT), accounting for 14%–20% of kidney transplantations (KTx) in the pediatric population 4–7 . Although improvement in sanitation and food hygiene may decrease its incidence, this does not seem to have occurred in recent years 8…”

Section: Introductionmentioning

confidence: 99%

A decrease in the incidence of Shiga toxin‐related hemolytic uremic syndrome as a cause of kidney transplantation at an argentine referral center

Monteverde

Panero

Chaparro

et al. 2023

Pediatric Transplantation

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Background In Argentina, Hemolytic uremic syndrome caused by Shiga toxin‐producing Escherichia coli (STEC HUS), is the main cause of acute kidney injury and the second cause of end‐stage renal disease (ESRD) in children. In recent decades, strategies have been implemented to reduce progression to ESRD, but it is not known whether the cumulative incidence of HUS requiring kidney transplantation (KTx) has decreased. We aimed to determine whether the cumulative incidence of STEC HUS in children undergoing KTx decreased and compared outcomes of HUS‐related KTx vs. those related to other etiologies. Methods All patients who underwent KTx at our institution were evaluated. The cohort was divided into quintiles (Q), and we compared the cumulative incidence of HUS‐related KTx vs KTx due to other etiologies. Results A total of 1000 consecutive KTx were included. The cumulative incidence of HUS‐related KTx was 11%. HUS was the second cause of KTx in Q1: 17% (1988–1995); Q2: 13.5% (1996–2003); Q3: 11.5% (2004–2009) and third cause in Q4: 10% (2010–2015) and Q5: 3% (2016–2021). The cumulative incidence of HUS‐related KTx decreased in Q4 and Q5 compared to Q1, Q2, and Q3 and the decline was even steeper when comparing Q4 to Q5 (p:0.019). There was no difference in graft survival in patients with HUS vs. congenital anomalies of kidney and urinary tract (CAKUT) but better than in those with focal segmental glomerulosclerosis (FSGS). Conclusions In this cohort, the cumulative incidence of HUS‐related KTx decreased, which may have been due to the implementation of nephroprotective strategies.

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Kidney transplantation in children with CAKUT and non‐CAKUT causes of chronic kidney disease: Do they have the same outcomes?

Abstract: Almost half the children who undergo kidney transplantation (KTx) have congenital abnormalities of the kidney and urinary tract (CAKUT). We compared patient, graft survival, and kidney function at last follow-up between CAKUT and non-CAKUT pa

Cited by 11 publications

References 40 publications

Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network database analysis

Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network database analysis

Clinical outcomes and temporal trends of immunological and non-immunological rare diseases in adult kidney transplant

A decrease in the incidence of Shiga toxin‐related hemolytic uremic syndrome as a cause of kidney transplantation at an argentine referral center

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