Long‐term outcome of deceased donor renal transplantation in pediatric recipients: A single‐center experience from a developing country

Abstract

RTx is best treatment for children with ESRD. Data scarcity on DDRTx outcome in children prompted us to review our experience. This study was undertaken to evaluate patient/graft survival, function vis-a-vis SCr, rejection episodes, and mortality in DDRTx performed in 37 children between 1998 and 2011. The most common recipient diseases leading to ESRD were congenital anomalies of kidney and urinary tract (48.6%) and chronic glomerulonephritis (18.9%). Mean recipient age was 13.8 ± 3.1 yr; 67.5% (n = 25) were men. Mean donor age was 38.8 ± 18.6 yr; 48.5% (n = 18) were men. Mean dialysis duration pre-transplantation was 15.5 ± 3.5 months. All recipients received r-ATG, and triple immunosuppression. Over a mean follow-up of 3.93 ± 3.5 yr, patient and graft survival rates were 72.9% (n = 27) and 83.7% (n = 31), respectively, with a mean SCr of 1.1 mg/dL; 21.6% (n = 8) of patients had acute rejection episodes; 24.3% (n = 9) of patients had DGF. A total of 27% (n = 10) patients died, mainly owing to infections (n = 6) and cardiovascular disease (n = 3). DDRTx is a viable option for children and achieves acceptable graft function with patient/graft survival over long-term follow-up, encouraging use of this approach.

Pediatric renal transplant practices in India

“…In the absence of availability of a trained pediatric nephrologist, children are often been managed and transplanted under the care of adult nephrologists. Although a clear national picture is lacking from India, the scarcity of publications suggests that pediatric transplantation is likely limited to a few centers across India, and a significant number of children with ESRD fail to avail this wonderful advancement in medical science . Absence of national or regional registry for pediatric renal transplant has also contributed to the current lack of knowledge on the present state of pediatric renal transplantation in India.…”

Outcome of renal transplantation from deceased donors: experience from developing country

“…Limited access to tertiary level health care, lack of facilities for chronic dialysis, scarcity of trained personnel, inadequate availability of health insurance, vascular access expertise, parental support, and transplant counselors are the other major obstacles for DDRT in our country. [4][5][6][7][8][9][10][11][12] In India, very few centers have a viable DDRT program. We present our experience of DDRT over the last 7 years.…”

Kidneys - kindergarten to graduation

“…Live related and deceased organ renal transplantation in children is gathering momentum in a few centers across the nation. [ 24 25 26 27 28 ] However, the real challenge lies not only in escalating the number of transplants but more importantly in optimizing the long-term care of the allograft posttransplant. The overall 5 years and 10 years graft survival are reported to be between 80–86% and 70–75%, respectively.…”

“…The overall 5 years and 10 years graft survival are reported to be between 80–86% and 70–75%, respectively. [ 24 25 26 27 28 ] Urological issues and interventions play a vital role in pediatric transplantation. Focal segmental glomerulosclerosis is a major cause for End Stage Renal Disease, and we have shown the variation in the genetic polymorphisms among Indian children[ 29 ] with recurrence post renal transplant[ 30 ] being an additional economic burden.…”