Pre-Emptive Pediatric Kidney Transplantation or Not?

García, Carmen; Bittencourt, V.; Rohde, R.; Dickel, Steffen; Pires, I.; Tumba, K.; Vitola, Santo Pascual; Souza, V. de; Wagner, Matthew; Garcı́a, Valter Duro

doi:10.1016/j.transproceed.2015.03.019

Cited by 9 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Results were similar after excluding four ( 8 , 24 – 26 ) studies with overlapping countries and study periods ( n = 16,314; RR: .54; CI: .47–.62; p < .0001; I 2 = 32.22%; Supplementary Figure S3 ). Eight of the 16 studies reported ratios adjusted for various confounders, using multivariate analyses or by matching the PKT and nPKT group ( 5 , 6 , 8 , 9 , 18 , 22 , 25 , 29 ). Pooling of these adjusted ratios showed a similar result ( n = 16,715; RR: .61; CI: .40–.92; p = .018; I 2 = 60.7%; Supplementary Figure S4 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Death-censored graft loss was reported in two studies ( 9 , 30 ) for LD and DD data combined. Garcia et al ( 9 ) reported a higher 12-, 36-, 60- and 90-month death-censored graft survival rate, adjusted by donor type, in PKT patients compared with nPKT patients (97% vs. 87%; 92% vs. 79%; 86% vs. 72%; 76% vs. 65%, respectively). The difference was significant at 90 months ( p < .05); however, the study did not clearly report if the differences were significant at the other time points.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Is Preemptive Kidney Transplantation Associated With Improved Outcomes when Compared to Non-preemptive Kidney Transplantation in Children? A Systematic Review and Meta-Analysis

Magar¹,

Knight²,

Stojanović

et al. 2022

Transpl Int

View full text Add to dashboard Cite

Main Problem: Preemptive kidney transplantation (PKT) is performed prior to dialysis initiation to avoid dialysis-related morbidity and mortality in children and adolescents. We undertook a systematic review to compare clinical outcomes in PKT versus kidney transplantation after dialysis initiation in paediatric patients.Methods: The bibliographic search identified studies that compared paediatric recipients of a first or subsequent, living or deceased donor PKT versus non-preemptive kidney transplant. Methodological quality was assessed for all studies. Data were pooled using the random-effects model.Results: Twenty-two studies (n = 22,622) were included. PKT reduced the risk of overall graft loss (relative risk (RR) .57, 95% CI: .49–.66) and acute rejection (RR: .81, 95% CI: .75–.88) compared to transplantation after dialysis. Although no significant difference was observed in overall patient mortality, the risk of patient death was found to be significantly lower in PKT patients with living donor transplants (RR: .53, 95% CI: .34–.83). No significant difference was observed in the incidence of delayed graft function.Conclusion: Evidence from observational studies suggests that PKT is associated with a reduction in the risk of acute rejection and graft loss. Efforts should be made to promote and improve rates of PKT in this group of patients (PROSPERO).Systematic Review Registration:https://clinicaltrials.gov/, CRD42014010565

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Is Preemptive Kidney Transplantation Associated With Improved Outcomes when Compared to Non-preemptive Kidney Transplantation in Children? A Systematic Review and Meta-Analysis

Magar¹,

Knight²,

Stojanović

et al. 2022

Transpl Int

View full text Add to dashboard Cite

show abstract

“…4 (p = 0.005). A previous study conducted on 323 children in Brazil, showed that graft and patient survival rates were signi cantly lower in non-pre-emptive transplanted children, when compared to pre-emptive transplants [31]. Additional studies in the past years have shown the superiority of pre-emptive transplantation on graft and patient survival, cardiac morbidity and avoidance of dialysis-related complications while minimizing the effect on growth and development associated with ESRD and dialysis in children [32,33].…”

Section: Discussionmentioning

confidence: 99%

Cytopenias in Pediatric Kidney Transplant Recipients: Risk Factors and Clinical Consequences

Regev-Sadeh

Borovitz

Steinberg‐Shemer

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose: To evaluate the characteristics of cytopenias in pediatric kidney transplant recipients (KTRs), identify predictors and assess management and consequences. Methods: A retrospective, single-center, case-control study of pediatric KTRs between the years 2000-2019. Possible risk factor for cytopenias were compared in multivariate Cox regression, with the aim of finding predictors for post-transplant thrombocytopenia (PTT) and post-transplant neutropenia (PTN). PTNs were analyzed for the total study period, and for the period beyond 6-months post-transplant (late PTNs), to rule-out the confounding influence of induction and initial intensive therapy.Results: 89 children were included in the study. Prevalence of PTT was 22%, all cases were mild or moderate. Post-transplant infections and graft rejection were found to be significant risk factors for PTT (HR 6.06, 95% CI 1.6-22.9, and HR 5.82, 95% CI 1.27-26.6, respectively). Overall PTN prevalence was 60%; 30% were severe (ANC ≤ 500(. Pre-transplant dialysis and post-transplant infections were significant predictors for late PTN (HR 11.2, 95% CI 1.45-86.4, and HR 3.32, 95% CI 1.46-7.57, respectively). Graft rejection occurred in 10% of KTRs with cytopenia, all following neutropenia, within 3 months from cytopenia appearance. In all such cases, mycophenolate mofetil dosing had been held or reduced prior to the rejection. One case resulted in graft-loss. Conclusions: Post-transplant infections are substantial contributors for developing PTTs and PTNs. Pre-emptive transplantation appears to reduce risk for late PTN, the accompanying reduction in immunosuppressive therapy and the ensuing risk for graft rejection. An alternative response to PTN, possible with granulocyte colony stimulating factor (G-CSF), may diminish graft loss.

show abstract

“…O transplante preemptivo, antes de iniciar a diálise, parece ser a melhor terapia para crianças com doença renal em estágio terminal (DRET), oferecendo a possibilidade de restabelecer a função renal normal e eliminar inúmeras manifestações clínicas da doença renal 8,9 . Entretanto, este procedimento também apresenta diversos efeitos colaterais, principalmente entre crianças, nas quais as respostas imunológicas são mais intensas 10 .…”

Section: Introductionunclassified

Redução da força muscular periférica e respiratória em pacientes pediátricos após transplante renal

Frantzeski

Thomazi²,

Pinho

et al. 2023

Braz. J. Nephrol.

View full text Add to dashboard Cite

Resumo ntrodução: Força muscular reduzida e baixa capacidade de exercício encontram-se bem documentadas em adultos mas há poucos estudos examinando essas alterações em crianças e adolescentes após transplante renal. O objetivo deste estudo foi avaliar a força muscular periférica e respiratória e a associação com a capacidade submáxima de exercício em crianças e adolescentes após o transplante renal. Métodos: Foram incluídos 47 pacientes entre 6 e 18 anos de idade clinicamente estáveis após o transplante. Avaliou-se a força muscular periférica (dinamometria isocinética e de preensão manual), a força muscular respiratória (pressão inspiratória e expiratória máximas) e a capacidade submáxima de exercício (teste de caminhada de seis minutos – TC6M). Resultados: Os pacientes apresentaram média de idade de 13,1 ± 2,7 anos e uma média de 34 meses desde o transplante. Os flexores de joelho mostraram uma redução significativa na força muscular (77,3% do previsto) e os extensores de joelho apresentaram valores normais (105,4% do previsto). A força de preensão manual e as pressões respiratórias máximas (inspiratória e expiratória) foram significativamente inferiores ao esperado (p < 0,001). Embora a distância percorrida no TC6M tenha sido significativamente menor do que o previsto (p < 0,001), não encontramos nenhuma correlação significativa com a força muscular periférica e respiratória. Conclusão: Crianças e adolescentes submetidos ao transplante renal apresentam força muscular periférica reduzida de flexores de joelho e de preensão manual, bem como das pressões respiratórias máximas. Não foram encontradas associações entre força muscular periférica e respiratória e a capacidade submáxima de exercício.

show abstract

Pre-Emptive Pediatric Kidney Transplantation or Not?

Cited by 9 publications

References 10 publications

Is Preemptive Kidney Transplantation Associated With Improved Outcomes when Compared to Non-preemptive Kidney Transplantation in Children? A Systematic Review and Meta-Analysis

Is Preemptive Kidney Transplantation Associated With Improved Outcomes when Compared to Non-preemptive Kidney Transplantation in Children? A Systematic Review and Meta-Analysis

Cytopenias in Pediatric Kidney Transplant Recipients: Risk Factors and Clinical Consequences

Redução da força muscular periférica e respiratória em pacientes pediátricos após transplante renal

Contact Info

Product

Resources

About