Abstract
Our objective was to study the complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Between March 1976 and December 2005, 1,785 live-donor kidney transplantations were carried out at our center. Of the recipients, 292 were 20 years old or younger (mean age 12.8 years, ranging from 4 years to 20 years). Clinical and laboratory parameters of these 292 patients were analyzed retrospectively. They were 182 boys and 110 girls. Patients who had received transplants before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998, a triple regimen comprising prednisolone, azathioprine and cyclosporine A (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as primary therapy in 1998. Growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications were assessed. Triple-drug immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%; chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation scores (SDSs) of less than −1.88. The overall infection rate was high, and the majority (54%) was bacterial. Malignancy was diagnosed in eight (3%) patients. The incidence of urological complications was 14%, and that of vascular complications was 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases, with the distal muscles of lower limbs more affected. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. We concluded that, despite the long-term success of pediatric renal transplantation in a developing country, there is a risk of significant morbidity.
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References
Mir S, Erdogan H, Serdaroglu E, Kabasakal C, Hoscoskun C (2005) Pediatric renal transplantation: single center experience. Pediatr Transplant 9:56–61
Hogg RJ, Furth S, Lemley KV (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification, and Stratification. Pediatrics 11:1416–1421
Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590
Karthikeyan V, Karpinski J, Nair RC, Knoll G (2004) The burden of chronic kidney disease in renal transplant recipients. Am J Transplant 4:262–269
Bertoni E, Rosati A, Larti A, Merciai C, Zanazzi M, Rosso G, Gallo M, Marcucci R, Salvadori M (2006) Chronic kidney disease is still present after renal transplantation with excellent function. Transplant Proc 38:1024–1025
Djamali A, Kendziorski C, Brazy PC, Becker BN (2003) Disease progression and outcomes in chronic kidney disease and renal transplantation. Kidney Int 64:1800–1807
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 34:571–576
National Kidney Foundation (2002) K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am J Kidney Dis 39:S1–266
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576
National Kidney Foundation (2006) KDOQI. III. Clinical practice recommendations for anemia in chronic kidney disease in children. Am J Kidney Dis 47:S86–S108
Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618
Levy D, Garrison RJ, Davage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med 322:1561–1566
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) Perspective: the diagnosis of osteoporosis. J Bone Miner Res 9:1137–1142
Everitt BS (1994) Statistical methods for medical investigators, 2nd edn. Wiley, New York
Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Akhtar F, Hussain M, Ahmed E, Zafar MN, Hafiz S, Muzaffar R, Jawad F (2003) Renal transplantation in developing countries. Kidney Int Suppl 83:S96–S100
McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, Jones DP (2006) Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant 10:558–564
Mitsnefes MM, Subat–Dezulovic M, Khoury PR, Goebel J, Strife CF (2005) Increasing incidence of post-kidney transplant anemia in children. Am J Transplant 5:1713-1718
Goksen D, Darcan S, Kara P, Mir S, Coker M, Kabasakal C (2005) Bone mineral density in pediatric and adolescent renal transplant patients: how to evaluate. Pediatr Transplant 9:464–469
Mentzel HJ, John U, Boettcher J, Malich A, Pfeil A, Vollandt R, Misselwitz J, Kaiser WA (2005) Evaluation of bone-mineral density by digital X-ray radiogrammetry (DXR) in pediatric renal transplant recipients. Pediatr Radiol 35:489–494
El-Husseini A, Foda M, Osman Y, Sobh M (2006) Characteristics of long-term live-donor pediatric renal transplant survivors: a single-center experience. Pediatr Transplant 10:288–293
Chantler C, Broyer M, Donckerwolcke RA, Brynger H, Brunner FP, Jacobs C, Kramer P, Selwood NH, Wing AJ (1981) Growth and rehabilitation of long-term survivors of treatment for end stage renal failure in childhood. Proc Eur Dial Transplant Assoc 18:329–342
Potter DE, Najarian J, Belzer F, Holliday MA, Horns G, Salvatierra O (1991) Long-term results of renal transplantation in children. Kidney Int 40:752–756
Offner G, Latta K, Hoyer PF, Baum HJ, Ehrich JH, Pichlmayr R, Brodehl J (1999) Kidney transplanted children come of age. Kidney Int 55:1509–1517
Bartosh S, Leverson G, Robillard D, Sollinger H (2003) Long term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation 76:1195–1200
El-Agroudy A, Refaie A, Moussa O, Ghoneim M (2003) Tuberculosis in Egyptian kidney transplant recipients: study of clinical course and outcome. J Nephrol 16:404–411
Shah N, Al-Khoury S, Afzali B, Covic A, Roche A, Marsh J, Macdougall C, Goldsmith J (2006) Posttransplantation anemia in adult renal allograft recipients: prevalence and predictors. Transplantation 81:1112–1118
Wühl E, Mehls O, Schaefer F; ESCAPE Trial Group (2004) Antihypertensive and antiproteinuric efficacy of ramipril in children with chronic renal failure. Kidney Int 66:768–776
Rees L, Shroff R, Hutchinson C, Fernando ON, Trompeter RS (2007) Long-term outcome of paediatric renal transplantation: follow-up of 300 children from 1973 to 2000. Nephron Clin Pract 105:c68–c76
Bullington N, Kartel J, Khoury P, Mitsnefes M (2006) Left ventricular hypertrophy in pediatric kidney transplant recipients: long-term follow-up study. Pediatr Transplant 10:811–815
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 16:1212–1215
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 63:1405–1410
Cimic J, Meuleman EJ, Oosterhof GO, Hoitsma AJ (1997) Urological complications in renal transplantation. A comparison between living-related and cadaveric grafts. Eur Urol 31:433–435
Berg UB, Bohlin A, Tyden G (1996) Influence of donor and recipient ages and sex on graft function after pediatric renal transplantation. Transplantation 64:1424–1428
Khauli RB (1994) Surgical aspects of renal transplantation: New approaches. Urol Clin North Am 21:321–341
Zaontz MR, Hatch DA, Firlit CF (1988) Urological complications in pediatric renal transplantation: management and prevention. J Urol 140:1123–1128
Sheldon CA, Churchill BM, Khoury AE, McLorie GA (1992) Complications of surgical significance in pediatric renal transplantation. J Pediatr Surg 4:485–489
Patchell RA (1994) Neurological complications of organ transplantation. Ann Neurol 36:688–703
Guiheneuc P (1997) Peripheral neuropathies of chronic renal insufficiency review. Nephrologie 18:165–173
Burn JD, Bates D (1998) Neurology and the kidney. J Neurol Neurosurg Psychiatry 65:810–882
Feber J, Cochat P, Braillon P (1994) Bone mineral density after renal transplantation in children. J Pediatr 125:870–875
Leonard MB (2005) Assessment of bone mass following renal transplantation in children. Pediatr Nephrol 20:360–367
Saland JM, Goode ML, Haas DL, Romano TA, Seikaly MG (2001) The prevalence of osteopenia in pediatric renal allograft recipients varies with the method of analysis. Am J Transplant 1:243–250
El-Husseini AA, El-Agroudy AE, El-Sayed MF, Sobh MA, Ghoneim MA (2004) Treatment of osteopenia and osteoporosis in renal transplant children and adolescents. Pediatr Transplant 8:357–361
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El-Husseini, A.A., Sobh, M.A. & Ghoneim, M.A. Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt. Pediatr Nephrol 23, 2067–2073 (2008). https://doi.org/10.1007/s00467-007-0669-x
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DOI: https://doi.org/10.1007/s00467-007-0669-x