Abstract
Objective
To assess the role native nephrectomy (NN) in hypertension-related outcomes for pediatric patients undergoing renal transplantation (RT).
Methods
Renal transplants (RT) performed at our institution between 2006 and 2015 were reviewed. RT recipients who underwent NN were compared to those who did not. Primary outcomes were hypertension-related: use/number of medications pre-/post-transplant and hypertension-related readmissions. Secondary outcomes were 1-year outcomes of: readmissions, eGFR, Clavien–Dindo classification ≥ 3 complications, and graft loss.
Results
135 patients were evaluated. 24 underwent NN (Group 1) and 111 did not (Group 2). Baseline characteristics were similar between Groups 1 and 2. The majority of NN indications were hypertension (10/39 kidneys) and proteinuria (12/39 kidneys). There were no differences in use/number of anti-hypertensive medications pre- or post-transplant. However, between Group 2 and subgroup of patients who underwent NN for hypertension, a significant difference was seen in medication use/numbers but not post-transplant. Number of readmissions due to hypertension was similar (7.2% vs. 12.5%). The only difference in secondary outcomes was higher readmission rates with bacterial infections for group 1 (45.8% vs. 23.4%, p = 0.041).
Conclusion
NN, when offered to patients at higher risk of post-RT hypertension, may allow high-risk patients to achieve similar hypertension outcomes as those at lower risk.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- NN:
-
Native nephrectomy
- RT:
-
Renal transplant
- ESRD:
-
End-stage renal disease
References
Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730
Rabbat CG, Thorpe KE, Russell JD et al (2000) Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol 11:917–922
Cochat P, Ranchin B (2001) Is there a need for a multicenter study to determine the optimal approach to recurrent nephrotic syndrome following renal transplantation? Pediatr Transplant 5:394–397
Sharbaf FG, Bitzan M, Szymanski KM et al (2012) Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatr Nephrol 27:1179–1188
Smith JM, Ho PL, McDonald RA (2002) Renal transplant outcomes in adolescents: a report of the North American pediatric renal transplant cooperative study. Pediatr Transplant 6:493–499
Brubaker AL, Stoltz DJ, Chaudhuri A et al (2018) Superior hypertension management in pediatric kidney transplant patients after native nephrectomy. Transplantation 102(7):1172–1178
Cavallini M, Di Zazzo G, Giordano U et al (2010) Long-term cardiovascular effects of pre-transplant native kidney nephrectomy in children. Pediatr Nephrol 25:2523–2529
Sharbaf FG, Bitzan M, Szymanski KM et al (2012) Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatr Nephrol 27:1179–1188
Fraser N, Lyon PC, Williams AR et al (2013) Native nephrectomy in pediatric transplantation—less is more! J Pediatr Urol 9:84–89
Schwartz GJ, Munoz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637
Myers GL, Miller WG, Coresh J et al (2006) Recommendations for improving serum creatinine measurement: a report from the laboratory working group of the national kidney disease education program. Clin Chem 52:5–18
Palmer B, Kropp B (2018) Urologic evaluation and management of pediatric kidney transplants. Urol Clin N Am 45:561–569
Charnaya O, Moudgil A (2017) Hypertension in the pediatric kidney transplant recipient. Front Pediatr 5:86
Kliegman RM, Behrman RE, Jenson HB et al (2007) Nelson textbook of pediatrics, 18th edn. Saunders, Philadelphia, pp 2193–2194
Power RE, Calleary JG, Hickey DP (2001) Pre-transplant bilateral native nephrectomy for medically refractory hypertension. Ir Med J 94(7):214–216 (PMID: 11693214)
El Mashad GM, El Hady Ibrahim SA, Abdelnaby SAA (2017) Immunoglobulin G and M levels in childhood nephrotic syndrome: two centers Egyptian study. Electron Physician 9(2):3728–3732
Shoma AM, Eraky I, El-kappany HA (2003) Pretransplant native nephrectomy in patients with end-stage renal failure: assessment of the role of laparoscopy. Urology 61:915–919
Glassman DT, Nipkow L, Bartlett ST, Jacobs SC (2000) Bilateral nephrectomy with concomitant renal graft transplantation for autosomal dominant polycystic kidney disease. J Urol 164:661–664
Sanfillippo F, Vaughn WK, Spees EK (1984) The association of pretransplant native nephrectomy with decreased renal allograft rejection. Transplantation 37:256–260
Funding
The study does not have any financial disclosures.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Kim, J.K., Lorenzo, A.J., Raveendran, L. et al. Impact of native nephrectomy on hypertension outcomes in pediatric kidney transplant recipients: a 10-year institutional experience. Pediatr Surg Int 38, 623–629 (2022). https://doi.org/10.1007/s00383-022-05080-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-022-05080-8