Abstract
tBackground
Paediatric kidney transplantation has different aspects in adults in terms of underlying primary renal disease, surgical technique, perioperative care and graft prognosis. Significant urological problems are present in a high percentage of paediatric recipients. This study was undertaken to characterize paediatric kidney transplantation as performed at our institutes.
Methods
Twenty-eight patients (age range 4–17 years, 10 girls, 18 boys) were included in this study. We analyzed (1) urologic procedures performed prior to or simultaneously with transplantation, (2) intraoperative changes in haemodynamics, (3) postoperative complications and (4) acute allograft rejection and graft prognosis.
Results
Of 4 patients with lower urinary tract abnormalities (neurogenic bladder in 3, posterior urethral valve in 1), 2 underwent augmentation ileocystoplasty prior to transplantation. The Mitrofanoff procedure as a diversion for neourethra was also performed in 2 of the 4 patients. All these 4 patients were managed with clean intermittent catheterization. Central venous pressure changes before and after graft vessel declamping were much greater in patients with body weight below 25 kg than in those above 25 kg. Five surgical complications and 6 infections were encountered postoperatively and hypertension was lasting in 6. Thirteen patients experienced 19 periods of acute allograft rejection. All of the 24 patients in the cyclosporin era (1986-) overcame rejections and they are all alive with good graft function.
Conclusions
As long as proper pretransplant patient evaluation and management, and intensive perioperative care are undertaken, good prognosis of renal allograft can be achieved in young patients.
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References
Avner, E. D., Chavers, B., Sullivan, E. K., Tejani, A.: Renal transplantation and chronic dialysis in children and adolescents: The 1993 annual report of the North American Pediatric Renal Transplant Cooperative Study?Pediatr. Nephrol., 9, 61 (1995).
Churchill, B. M., McLorie, G. A., Williot, P., McMullin, N., Thompson, D., Aliabadi, H., Sheldon, C. A.: Pediatric renal transplantation.World J. Urol., 6, 78 (1988).
Tejani, A., Stablein, D., Alexander, S., Fine, R., Harmon, W.: Analysis of rejection out-comes and implications—A report of the North American Pediatric Renal Transplant Cooperative Study.Transplantation, 59, 500 (1995).
Duckett, J. W., Snyder, III, H. M.: Continent urinary diversion: Variations on the Mitrofanoff principle.J. Urol., 136, 58 (1986).
Seki, T., Takeuchi, I., Tanda, K., Chikaraishi, T., Kanagawa, K., Nonomura, K., Togashi, M., Koyanagi, T.: Improved success of pediatric renal transplantation.Transplant. Proc., 25, 2067 (1994).
Druck Garcia, C. D., Goldani, J. C., Menezes, M., Duro, Garcia, V.: Pediatric renal transplantation in the state of Rio Grande Do Sul, Brazil.Transplant. Proc., 27, 1830 (1995).
Tyden, G., Berg, U.: Pediatric renal transplantation in the Nordic Countries.Transplant. Proc., 27, 3440 (1995).
Churchill, B. M., Sheldon, C. A., McLorie, G. A., Arbus, G. S.: Factors influencing patient and graft survival in 300 cadaveric pediatric renal transplants.J. Urol., 140, 1129 (1988).
Gonzalez, R., LaPointe, S., Sheldon, C. A., Mauer, M. S.: Undiversion in children with renal failure.J. Pediatr. Surg., 19, 632 (1984).
Barnett, M. G., Bruskewitz, R. C., Belzer, F. O., Sollinger, H. W., Uehling, D. T.: Ileocecocystoplasty bladder augmentation and renal transplantation.J. Urol., 138 855 (1987).
Kakizaki, H., Morita, H., Seki, T., Togashi, M., Koyanagi, T.: An experience of augmentation ileocystoplasty and renal transplantation in a defunctionalized congenital neurogenic bladder patient.Jpn. J. Urol. Surg., 2, 1053 (1989).
Flechner, S. M., Conley, S. B., Brewer, E. D., Benson, G. S., Corriere, J. N. Jr.: Intermittent clean catheterization: An alternalive to diversion in continent transplant recipients with lower urinary tract dysfunction.J. Urol., 130, 878 (1983).
Fine, R., Tejani, A., Sullivan, E. K.: Pre-emptive renal transplantation in children. Report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).Clin. Transplant., 18, 214 (1994).
Ettenger, R., Marik, J., Rosenthal, J. T.: Sequential therapy in pediatric cadaveric renal transplantation: A critical analysis.J. Am. Soc. Nephrol., 2, S304 (1992).
Shapiro, R., Scantlebury, V. P., Jordan, M. L., Vivas, C., Tzakis, A. G., Ellis, D., Giboa, N., Hopp, L., McCauley, J., Irish, W., Mitchell, S., Hakala, T. R., Simmons, R. L., Starzl, T. E.: FK506 in pediatric kidney transplantation—Primary and rescue experience.Pediatr. Nephrol., 9, S43 (1995).
Kahan, B. D., Conley, S., Portman, R., Lemaire, R., Wideman, C., Flechner, S., Van Buren, C.: Parent-to-child transplantation with cyclosporine immunosuppression.J. Pediatr., 111, 1012 (1987).
Sakuma, T., Ogawa, O., Kawamura, T., Hasegawa, A., Kamidono, S.: Blood levels of cyclosporine, acute rejections and the prognosis of the allografts in pediatric renal allograft recipients.Jpn. J. Urol., 86, 1450 (1995).
Seki, T., Tanda, K., Chikaraishi, T., Takeuchi, I., Togashi, M., Koyanagi, T.: Addition of deoxyspergualin to standard triple immunosuppressive regimen in kidney transplantation.Transplant. Proc., 28, 1352 (1996).
Rivkees, S. A., Danon, M., Herrin, J.: Prednisone dose limitation of growth hormone treatment of steroid-induced growth failure.J. Pediatr., 125, 322 (1994).
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Morita, K., Seki, T., Kakizaki, H. et al. Experience with kidney transplantation in children and adolescents. International Urology and Nephrology 30, 627–637 (1998). https://doi.org/10.1007/BF02550558
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DOI: https://doi.org/10.1007/BF02550558