Pediatric renal transplantation: an overview and update

Gulati, Ashima; Sarwal, Minnie M.

doi:10.1097/mop.0b013e32833683fd

Cited by 59 publications

(64 citation statements)

References 50 publications

(51 reference statements)

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“…Transplants were categorized into 4 time periods (1987-1993, 1994-2001, 2002-2004, and 2005-2012) to reflect changes in immunosuppression practices over time (in general, increased use of tacrolimus and mycophenolate mofetil, decreased use of cyclosporine and azathioprine, and introduction of interleukin-2 receptor monoclonal antibodies) 4 and implementation in 2005 of the Share-35 allocation policy, which includes preference to pediatric recipients in the allocation of organs from deceased donors under age 35. 6 Outcome Ascertainment Death-censored graft survival (DCGS) was defined as the time between date of KT and either date of graft failure (marked by retransplantation or return to dialysis) or last date of follow-up with a functioning graft, censoring for death and administrative end of study.…”

Section: Study Populationmentioning

confidence: 99%

“…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 nonfunction (PNF) and delayed graft function (DGF), and patient survival independent of concurrent variations in recipient and donor characteristics, to compare the early and late posttransplant periods with regard to trends in graft and patient survival, and to evaluate whether any changes in graft and patient survival differ in particular recipient subgroups.…”

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confidence: 99%

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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: Study Populationmentioning

confidence: 99%

mentioning

confidence: 99%

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

et al. 2014

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“…LD reduces the additional morbidity and mortality factors associated with the waiting time for a DBD organ [17]. Parents represent 80 % of LD [18]. The minimum legal age for living donation varies by jurisdiction, ranging from no minimum age limit (in England, Wales and North Ireland) to age 19 years in some Canadian provinces, with underaged living donation even forbidden in some European countries, including France [19].…”

Section: Pediatric Organ Donors and Their Managementmentioning

confidence: 99%

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

et al. 2014

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In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemiareperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.

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“…At present times the risk of post-surgical immediate graft failure is uncommon [1], and new immunosuppressive protocols have greatly reduced the risk of immunological acute rejection; chronic rejection and subclinical rejection, as well as allograft nephropathy remain the great challenges of paediatric KT. [2] Through the use of aggressive treatment protocols for acute rejection, the susceptibility to infection and secondary neoplastic disease were greatly increased, as shown in our 2 case presentations.…”

Section: (Figure 1)mentioning

confidence: 99%