Renal Transplantation in Infants

Najarían, John S.; Frey, Daniel; Matas, Arthur J.; Gillingham, Kristen J.; So, Samuel; Cook, Marie; Chavers, Blanche M.; Mauer, S. Michael; Nevins, Thomas E.

doi:10.1097/00000658-199009000-00014

Cited by 93 publications

(30 citation statements)

References 28 publications

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“…Several reviews have shown an increased mortality in young children and particularly in those <2 years of age at transplant: in two early studies there was a mortality rate of 21% [19, 20]; however, more recently, we and others have reported survival rates of >98% [6, 21]. Increased risk of death extends up to age 5 years at transplant: Dutch data showed that the mortality rate was nearly twice as high in those <5 years of age in comparison to 6- to 10-year-old children [3]; 19% died in a recent review of children with an average age of 4.7 years who weighed <20 kg at transplant [22].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000

Rees¹,

Shroff²,

Hutchinson³

et al. 2006

Nephron Clin Pract

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Background/Aim: To report our experience of paediatric renal transplantation at Great Ormond Street and Royal Free Hospitals since the inception of the programme. Methods: Retrospective review of the patient and transplant survival and influencing factors in the 300 children transplanted between 1973 and 2000. Results: 300 children had received a total of 354 transplants; 56 were living-related donations. The median age at transplantation was 10.3 (range 1.4–17.9) years. Forty-four percent had congenital structural abnormalities of the urinary tract. Forty-six children required a second and 8 a third transplant before transfer to an adult unit. The overall patient survival at 5, 10, and 20 years was 97, 94, and 72%, respectively. In the overall cohort, the donor type (deceased donor or living-related donor) did not affect mortality, nor did age at transplantation, but those transplanted before 5 years of age had a significantly shorter post-transplant survival time (p < 0.0001). Transplant survival (first transplant) for deceased and living-related donors was 66 and 87% at 5 years (p < 0.01), 51 and 54% at 10 years, and 36% at 20 years (deceased-donor transplants only). Although the overall transplant survival was inferior in children transplanted before 2 years of age (p < 0.03), in the most recent cohort (1990–2000), age did not affect the outcome. On multiple regression analysis, the only predictor of transplant survival was the era of transplantation (p < 0.001). The median final height was within the normal range for males and females; 7 patients received growth hormone after transplantation. Conclusions: The outlook for successful transplantation is improving, and in the last decade was unaffected by age at transplantation. The survival of living-related donor transplants is superior to deceased-donor transplants for the first 5 years. From the above data, we can predict that a 10-year-old child receiving a renal transplant in 2000 and on ciclosporin-based immunosuppression can expect a transplant half-life of 13.1 years from a living-related donor and one of 10.8 years from a deceased-donor transplant.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000

Rees¹,

Shroff²,

Hutchinson³

et al. 2006

Nephron Clin Pract

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“…However, in recent years excellent results of renal transplantation have been reported in children under 5 [12,13,16]. In a large series from Minnesota, Najarian and coworkers [15] reported a 5-year graft survival rate using LRD of 73% in 75 infants under 2 years of age.…”

Section: Discussionmentioning

confidence: 99%

End-stage renal failure in children younger than 6 years: renal transplantation is the therapy of choice

Vester

Offner

Hoyer

et al. 1998

European Journal of Pediatrics

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“…Nutritional management in infants with CRF is a major challenge and several measures have been proposed in order to prevent malnutrition, including strict conservative treatment, enteral feeding, peritoneal dialysis [18], and early transplantation [19]. Van Dyck et al [20] prevented growth retardation in 20 infants with CRF by using a strict conservative treatment consisting of a protein-restricted, calorie-enriched diet with supplements of essential amino acids (20% of the protein intake).…”

Section: Comparison Of Growth Between Group a And Group Bmentioning

confidence: 99%

Early prognostic factors of infants with chronic renal failure caused by renal dysplasia

Ismaïli

Schurmans

Wissing

et al. 2001

Pediatric Nephrology

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Renal dysplasia (RD) is a common cause of chronic renal failure (CRF) in children. The evolution towards end-stage renal failure is unpredictable due to the paucity of early prognostic factors. In order to identify early prognostic clinical criteria, we have retrospectively analyzed renal function and growth in 11 infants with RD and CRF from birth up to 4 years of age. Children with obstructive RD were not included. Glomerular filtration rate (GFR) was estimated from Schwartz formula. In infants with a GFR below 15 ml/min per 1.73 m2 at 6 months of age (group A, n=5), kidney function did not further improve; 4 reached end-stage renal failure between 8 months and 6 years of age. In contrast, infants with a GFR above 15 ml/min per 1.73 m2 at 6 months of age (group B, n=6) experienced a significant improvement in renal function during follow-up, and none required renal replacement therapy. During the first 3 months of life all infants with RD and CRF developed severe growth retardation. Between 6 months and 4 years of age, children from group B grew significantly better than those from group A. In conclusion, our experience suggests that GFR, estimated from Schwartz formula at 6 months of age, is a useful prognostic factor in infants with RD and CRF. Infants with a GFR below 15 ml/min per 1.73 m2 are at risk of severe growth delay and the need for early renal replacement therapy, whereas those with a GFR above 15 ml/min per 1.73 m2 have a relatively favorable long-term prognosis.

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Renal Transplantation in Infants

Cited by 93 publications

References 28 publications

Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000

Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000

End-stage renal failure in children younger than 6 years: renal transplantation is the therapy of choice

Early prognostic factors of infants with chronic renal failure caused by renal dysplasia

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