Advertisement

Pediatric Nephrology

, Volume 21, Issue 10, pp 1464–1470 | Cite as

Pediatric live-donor kidney transplantation in Mansoura Urology & Nephrology Center: a 28-year perspective

  • Amr A. El-HusseiniEmail author
  • Mohamed A. Foda
  • Mohamed A. Bakr
  • Ahmed A. Shokeir
  • Mohamed A. Sobh
  • Mohamed A. Ghoneim
Original Article

Abstract

Our objective was to evaluate our overall experience in pediatric renal transplantation. Between March 1976 and March 2004, 1,600 live-donor kidney transplantations were carried out in our center; 216 of the patients were 18 years old or younger (mean age 12.9 years). There were 136 male patients and 80 female patients. The commonest causes of end-stage renal disease (ESRD) were renal dysplasia (22%), nephrotic syndrome (20%), hereditary nephritis (16%), and obstructive uropathy (16%). Of the donors, 94% were one-haplotype matched and the rest were identical. Pre-emptive transplantation was performed in 51 (23%) patients. Triple-therapy immunosuppression (prednisone + cyclosporine + azathioprine) was used in 78.2% of transplants. Rejection-free recipients constituted 47.7%. Hypertension (62%) was the commonest complication. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than −1.88. The overall infection rate was high, and the majority (53%) of infections were bacterial. The graft survival at 1 year, 5 years and 10 years were 93.4%, 73.3% and 48.2%, respectively, while the patients’ survival at 1, 5 and 10 years were 97.6%, 87.8% and 75.3%, respectively. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk of significant morbidity.

Keywords

Children Kidney transplantation Live-donor Single-center 

Notes

Acknowledgment

The authors would like to thank Dr. Sherine Hamdy for her help in proofreading the article.

References

  1. 1.
    Mir S, Erdogan H, Serdaroglu E, Kabasakal C, Hoscoskun C (2005) Pediatric renal transplantation: single center experience. Pediatr Transplant 9:56–61CrossRefGoogle Scholar
  2. 2.
    Tejani A, Stablein DM, Donaldson L, Harmon WE, Alexander SR, Kohaut E, Emmett E, Fine RN (1999) Steady improvement in short-term graft survival of pediatric renal transplants: the NAPRTCS experience. In: Cecka JM, Terasaki PI (eds) Clinical transplants. ULCA Immunogenetics Center, Los Angeles, pp 95–105Google Scholar
  3. 3.
    Hardy B, Cicciarelli JC, Iwaki Y, Shaul D, Mendez R (1995) Parameters governing graft survival in pediatric renal transplant recipients. Transplant Proc 27:1086–1088PubMedGoogle Scholar
  4. 4.
    Cecka JM, Gjertson DW, Terasaki PI (1997) Pediatric renal transplantation: a review of the UNOS data. Pediatr Transplant 1:55–64PubMedGoogle Scholar
  5. 5.
    Tejani A, Stablein DM, Sullivan EK, Alexander SR, Fine RN, Harmon WE, Kohaut EC (1998) The impact of donor source, recipient age, pre-operative immunotherapy and induction therapy on early and late acute rejections in children: a report of the North American Pediatric Renal transplant Cooperative Study (NAPRTCS). Pediatr Transplant 2:318–324PubMedGoogle Scholar
  6. 6.
    Ishitani M, Isaacs R, Norwood V, Nock S, Lobo P (2000) Predictors of graft survival in pediatric living-related kidney transplant recipients. Transplantation 70:288–292CrossRefGoogle Scholar
  7. 7.
    Gjertson DW, Cecka JM (2001) Determinants of long-term survival of pediatric kidney grafts reported to the United Network for Organ Sharing kidney transplant registry. Pediatr Transplant 5:5–15CrossRefGoogle Scholar
  8. 8.
    Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am 34:571–576CrossRefGoogle Scholar
  9. 9.
    Everitt BS (1994) Statistical methods for medical investigators, 2nd edn. Wiley, New YorkGoogle Scholar
  10. 10.
    Ghoneim MA, Bakr MA, Hassan NA, Wahba WI, Fouda AS, Sobh MA, Shehab el-Dein AB, Shokeir AA, El-Mekresh MM, Ali-el-Dein B, Osman YM, Moustafa A, el-Chenawi F (2001) Live-donor renal transplantation at the Urology & Nephrology Center of Mansoura: 1976–1998. Clin Transplant 15:167–178CrossRefGoogle Scholar
  11. 11.
    Mahmoud A, Said MH, Dawahra M, Hadj-Aissa A, Schell M, Faraj G, Long D, Parchoux B, Martin X, Cochat P (1997) Outcome of preemptive renal transplantation and pretransplantation dialysis in children. Pediatr Nephrol 11:537–541CrossRefGoogle Scholar
  12. 12.
    Flom LS, Reisman EM, Donovan JM, Zaontz MR, Stein J, Firlit CF, Cohn RA (1992) Favorable experience with pre-emptive renal transplantation in children. Pediatr Nephrol 6:258–261CrossRefGoogle Scholar
  13. 13.
    Offner G, Hoyer PF, Meyer B, Pichlmayr R, Brodehl J (1993) Preemptive renal transplantations in children and adolescents. Transplant Int 6:125–128Google Scholar
  14. 14.
    Cransberg K, van Gool JD, Davin JC, de Jong MCJW, Darby M, Boendermaker ME, De Meester JMJ, Stijnen Th, Wolff ED, Nauta J (2000) Pediatric renal transplantations in the Netherlands. Pediatr Transplant 4:72–81CrossRefGoogle Scholar
  15. 15.
    Schurmann SJ, McEnery PT (1997) Factors influencing short-term and long-term pediatric renal transplant survival. J Pediatr 130:455–462CrossRefGoogle Scholar
  16. 16.
    Roodnat JI, van Riemsdijk IC, Mulder PGH, Doxiadis I, Claas FHJ, IJzermans JNM, van Gelder T, Weimar W (2003) The superior results of living-donor renal transplantation are not completely caused by selection or short cold ischemia time: a single-center, multivariate analysis. Transplantation 75:2014–2018CrossRefGoogle Scholar
  17. 17.
    McDonald R, Donaldson L, Emmett L, Tejani A (2000) A decade of living donor transplantation in North American children: the 1998 Annual Report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 4:221–234CrossRefGoogle Scholar
  18. 18.
    Ghoneim MA, Sobh MA, Shokeir AA, Bakr MA, Foda MA (1993) A prospective randomized study of azathioprine versus cyclosporin in live-donor kidney transplantation. Am J Nephrol 13:437–441CrossRefGoogle Scholar
  19. 19.
    Ghoneim MA, Sobh MA, Shokeir AA, Bakr MA, El-Sherif A, Foda MA (1993) Prospective randomized study of triple versus conventional immunosuppression in living related donor kidney transplantation. Transplant Proc 25:2243–2245PubMedGoogle Scholar
  20. 20.
    Benfield MR, McDonald L, Sullivan EK, Stablein DM, Tejani A (1999) The 1997 annual renal transplantation in children report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 3:152–167CrossRefGoogle Scholar
  21. 21.
    Tejani A, Sullivan EK (1999) The impact of acute rejection on chronic rejection: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 4:107–111CrossRefGoogle Scholar
  22. 22.
    Tejani A, Ho PL, Emmett L, Stablein DM (2002) North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Reduction in acute rejections decreases chronic rejection graft failure in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Transplant 2:142–147CrossRefGoogle Scholar
  23. 23.
    Baluarte HJ, Gruskin AB, Ingelfinger JR, Stablein D, Tejani A (1994) Analysis of hypertension in children post renal transplantation: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 8:570–573CrossRefGoogle Scholar
  24. 24.
    Sorof J, Sullivan E, Tejani A, Portman R (1999) Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study Report. J Am Soc Nephrol 6:1324–1330Google Scholar
  25. 25.
    El-Agroudy Amgad E, Refaie Ayman F, Moussa Omar M, Ghoneim Mohamed A (2003) Tuberculosis in Egyptian kidney transplant recipients: study of clinical course and outcome. J Nephrol 16:404–411PubMedGoogle Scholar
  26. 26.
    Lapointe SP, Charbit M, Jan D, Lortat-Jacab S, Michel J, Beurton D, Gagnadoux M, Niaudet P, Broyer M, Revillon Y (2001) Urological complications after renal transplantation using uretero-ureteral anastomosis in children. J Urol 166:1046–1048CrossRefGoogle Scholar
  27. 27.
    Tanabe K, Takahashi K, Kawaguchi H, Ito K, Yamazaki Y, Toma H (1998) Surgical complications of pediatric kidney transplantation: a single center experience with the extraperitoneal technique. J Urol 16:1212–1215Google Scholar
  28. 28.
    Satterthwaite R, Aswad S, Sunga V, Shidban H, Mendez RG, Bogaard T, Asai P, Khetan U, Magpayo M, Mendez R (1997) Outcome of en bloc and single kidney transplantation from very young cadaveric donors. Transplantation 63:1405–1410CrossRefGoogle Scholar
  29. 29.
    Gibbons WS, Barry JM, Hefty TR (1992) Complications following unstented parallel incision extravesical ureteroneocystostomy in 1000 kidney transplants. J Urol 148:38–40CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  • Amr A. El-Husseini
    • 1
    Email author
  • Mohamed A. Foda
    • 1
  • Mohamed A. Bakr
    • 1
  • Ahmed A. Shokeir
    • 1
  • Mohamed A. Sobh
    • 1
  • Mohamed A. Ghoneim
    • 1
  1. 1.Mansoura Urology & Nephrology CenterMansoura UniversityMansouraEgypt

Personalised recommendations