Long‐term outcome of pediatric renal transplantation: a single center experience

Abstract

Renal transplantation is the optimal treatment for pediatric end-stage renal disease. We examined 51 children <20 yr old who underwent a total of 52 living-donor renal transplantations at Osaka University Hospital between 1972 and 2004. The mean age at transplantation was 13.7 (3-19 yr). The mean duration of follow-up was 16.5 yr. The five-, 10-, and 20-yr patient survival rates following renal transplantation were 94%, 90%, and 87%, respectively. The five-, 10-, and 20-yr graft survival rates were 76%, 65%, and 48%, respectively. A double-drug regimen was used before 1987; this was replaced by a triple-drug regimen including a calcineurin inhibitor in 1988. The five-, 10-, and 20-yr graft survival rates after 1988 (89%, 80%, and 60%, respectively) were higher than those before 1987. Growth was examined among patients <15 yr old at the time of surgery, and height standard deviation (SD) scores (Z-scores) were analyzed in 14 patients who displayed favorable renal function after transplantation. At the time of transplantation, mean SD score (SDS) was -2.39, and mean final adult SDS was -1.79. Rates of patient and graft survival after renal transplantation were mostly favorable. Future goals must include overcoming chronic rejection and establishing a steroid discontinuation protocol to improve growth.

The impact of changing practice on improved outcomes of paediatric renal transplantation in the United Kingdom: a 25 years review

“…This compares favourably to published long-term outcome from national and regional registries. The published studies on the outcome of paediatric renal transplants are summarised in Table 4 [18][19][20][21][22][23][24][25][26][27][28][29].…”

Long‐term outcome of pediatric renal transplantation: A single center study in Japan

“…Because of a severe shortage of deceased donors, >80% of the transplanted kidneys come from live family donors in Japan . This led our philosophy to restrict to renal transplants in children weighing ≥15 kg because we believe that it is safer for them to receive a transplant from a living donor.…”

“…Many single center studies from different countries have reported the outcome of pediatric living‐donor renal transplantation . However, few single center studies are available on the long‐term outcome at 15–20 yr post‐transplant . In particular, only one single center study of pediatric renal transplantation has been reported from Japan .…”

“…However, few single center studies are available on the long‐term outcome at 15–20 yr post‐transplant . In particular, only one single center study of pediatric renal transplantation has been reported from Japan . The objective of this study was to describe the entire experience of pediatric renal transplantation at our center, consisting of the largest numbers of Japanese children, and to evaluate the risk factors for the long‐term poor outcome of renal transplantation in children.…”

Complications of nephrotic syndrome

“…CS induce overt elevation of serum IGF-1 levels, which results in the potential development of IGF resistance, one of the main factors responsible for persistent growth retardation45). Bone maturation and linear growth are delayed and arrested by long-term, high-dose CS therapy46), particularly when the dosage exceeds 0.5 mg/kg/day47). Therefore, the initial dose should be low in the range of 0.2 to 0.4 mg/kg (5 to 15 mg/m 2 ) per dose for treatment maintenance.…”