Preparing the pediatric dialysis patient for transplantation

  • M. Sarwal
  • O. SalvatierraJr.


Chronic dialysis in children is associated with the morbidity of cardiovascular disease1,2, infection3, nutrition, growth retardation and anemia4. Thus renal transplantation is the preferred definitive modality of treatment for pediatric end-stage renal disease (ESRD). Dialysis can be considered a “bridge” treatment in ESRD patients, supporting the uremic child to eventually benefit from normal renal function and improved quality of life and long-term survival with renal transplantation. Success with surgical and medical outcomes with renal transplantation in children of all ages, beginning as young as infancy, have led to unprecedented graft and patient outcomes in pediatric recipients of renal allografts5. As an example, the young recipient of a large adult-sized kidney transplant from a living donor, now stands to benefit from equivalent or greater graft survival rates than the “gold standard” of human leukocyte antigen (HLA)-identical twin transplantation in adults6, with graft half-lives approaching 30 years. In order to maximize graft and patient survival, there are a number of important considerations prior to transplantation which would include optimizing the overall medical status of the patient, surgical management of the native urinary tract, defining risks, histocompatibility testing and donor selection.


Peritoneal Dialysis Human Leukocyte Antigen Polycystic Kidney Disease Posterior Urethral Valve Congenital Nephrotic Syndrome 
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  1. 1.
    Chavers BM, Li S, Collins AJ, Herzog CA. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 2002;62(2):648–53.CrossRefGoogle Scholar
  2. 2.
    Litwin M, Grenda R, Prokurat S, Abuauba M, Latoszynska J, Jobs K, Boguszewska-Baczkowska A, Wawer ZT. Patient survival and causes of death on hemodialysis and peritoneal dialysis-single-center study. Pediatr Nephrol. 2001;16(12):996–1001.PubMedCrossRefGoogle Scholar
  3. 3.
    Wood EG, Hand M, Briscoe DM, Donaldson LA, Yiu V, Harley FL, Warady BA, Ellis EN. North American Pediatric Renal Transplant Cooperative Study. Risk factors for mortality in infants and young children on dialysis. Am J Kidney Dis. 2001;37(3):573–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Warady BA. Should the DOQI adequacy guidelines be used to standardize peritoneal dialysis in children? Perit Dial Int. 2001;21(Suppl 3):S174–8.PubMedGoogle Scholar
  5. 5.
    Cecka JM, Gjertson DW, Terasaki PI. Pediatric renal transplantation: a review of the UNOS data. United Network for Organ Sharing. Pediatr Transplant. 1997;l(l):55–64.Google Scholar
  6. 6.
    Sarwal MM, Cecka JM, Millan MT, Salvatierra O Jr. Adult-size kidneys without acute tubular necrosis provide exceedingly superior long-term graft outcomes for infants and small children: a single center and UNOS analysis. United Network for Organ Sharing. Transplantation. 2000;70(12):1728–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Reed EE, Roy LP, Gaskin KJ, Knight JF. Nutritional intervention and growth in children with chronic renal failure. J Ren Nutr. 1998;8(3):122–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Brewer ED. Pediatric experience with intradialytic parenteral nutrition and supplemental tube feeding. Am J Kidney Dis. 1999;33(l):205–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Parekh RS, Flynn JT, Smoyer WE, Milne JL, Kershaw DB, Bunchman TE, Sedman AB. Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol. 2001;12(11):2418–26.PubMedGoogle Scholar
  10. 10.
    Abitbol CL, Warady BA, Massie MD, Baluarte HJ, Fleischman LE, Geary DF, Kaiser BA, McEnery PT, Chan JC. Linear growth and anthropometric and nutritional measurements in children with mild to moderate renal insufficiency: a report of the Growth Failure in Children with Renal Diseases Study. J Pediatr. 1990;116(2):S46–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Guest G, Berard E, Crosnier H, Chevallier T, Rappaport R, Broyer M, Guest G, Berard E, Crosnier H, Chevallier T, Rappaport R, Broyer M. Effects of growth hormone in short children after renal transplantation. French Society of Pediatric Nephrology. Pediatr Nephrol. 1998;12(6):437–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Fine RN, Stablein D, Cohen AH, Tejani A, Kohaut E. Recombinant human growth hormone post-renal transplantation in children: a randomized controlled study of the NAPRTCS. Kidney Int. 2002;62(2):688–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Qvist E, Marttinen E, Ronnholm K, Antikainen M, Jalanko H, Sipila I, Holmberg C. Growth after renal transplantation in infancy or early childhood. Pediatr Nephrol. 2002;17(6):438–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Sarwal MM, Yorgin PD, Alexander S, Millan MT, Belson A, Belanger N, Granucci L, Major C, Costaglio C, Sanchez J, Orlandi P, Salvatierra O Jr. Promising early outcomes with a novel, complete steroid avoidance immunosuppression protocol in pediatric renal transplantation. Transplantation. 2001;72(1):13–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Thomas SE, Hickman HO, Tapper D, Shaw D, Fouser L, Mcdonald R. Asymptomatic inferior vena cava abnormalities in three children with end stage renal disease: Risk factors and screening guidelines for pre-transplant diagnosis. Pediatr Transplant. 2000;4:28–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Lilova MI, Velkovski IG, Topalov IB. Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974-1996). Pediatr Nephrol. 2000;15(l-2):74–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003;101(5):1827–32.PubMedCrossRefGoogle Scholar
  18. 18.
    Eichinger S, Weltermann A, Mannhalter C, Minar E, Bialonczyk C, Hirschl M, Schonauer V, Lechner K, Kyrie PA. The risk of recurrent venous thromboembolism in heterozygous carriers of factor V Leiden and a first spontaneous venous thromboembolism. Arch Intern Med. 2002;162(20):2357–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Becattini C, Agnelli G. Pathogenesis of venous thromboembolism. Curr Opin Pulm Med. 2002;8(5):360–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Soria JM, Almasy L, Souto JC, Buil A, Martinez-Sanchez E, Mateo J, Borrell M, Stone WH, Lathrop M, Fontcuberta J, Blangero J. A new locus on chromosome 18 that influences normal variation in activated protein C resistance phenotype and factor VIII activity and its relation to thrombosis susceptibility. Blood. 2003;101(1):163–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Refai TM, Al-Salem IH, Nkansa-Dwamena D, Al-Salem MH. Hyperhomocysteinaemia and risk of thrombosis in systemic lupus erythematosus patients. Clin Rheumatol. 2002;21(6):457–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Salvatierra O Jr, Singh T, Shifrin R, Conley S, Alexander S, Tanney D, Lemley K, Sarwal M, Mackie F, Alfrey E, Orlandi P, Zarins C, Herfkens R. Successful transplantation of adult-sized kidneys into infants requires maintenance of high aortic blood flow. Transplantation. 1998;66(7):819–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Savage T, Clarke AL, Giles M, Tomson CRV, Raine AEG. Calcified plaque is common in the carotid and femoral arteries of dialysis patients. Nephrol Dial Transplant. 1998;13(8):2004–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Friedman GS, Meier-Kriesche HU, Kaplan B, Mathis AS, Bonomini L, Shah N, DeFranco P, Jacobs M, Mulgaonkar S, Geffner S, Lyman N, Paraan C, Walsh C, Belizaire W, Tshibaka M. Hypercoagulable states in renal transplant candidates: impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation. 2001;72(6):1073–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002;141(2):191–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Wizemann V. Coronary artery disease in dialysis patients. Contrib Nephrol. 1998;124:1–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Frei U, Schindler R, Wieten D, Grouven U, Brunkhorst R, Koch KM. Pre-transplant hypertension: a major risk factor for chronic progressive allograft dysfunction? Nephrol Dial Transplant. 1995;10:1206–11.PubMedGoogle Scholar
  28. 28.
    Amann K, Gross ML, London GM, Ritz E. Hyperphosphatemia-a silent killer of patients with renal failure? Nephrol Dial Transplant. 1999;14:2085–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Leonard MB, Bachrach LK. Assessment of bone mineralization following renal transplantation in children: Limitations of DXA and the confounding effect of delayed growth and development. Amer J Transplant. 2001;1:193–6.CrossRefGoogle Scholar
  30. 30.
    Tenbrock K, Kruppa S, Mokov E, Querfeld U, Michalk D, Schonau E. Analysis of muscle strength and bone structure in children with renal disease. Pediatr Nephrol. 2000;14:669–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Sanchez CP, Salusky IB, Kuizon BD, Ramirez JA, Gales B, Ettenger RB, Goodman WG. Bone disease in children and adolescents undergoing successful renal transplantation. Kidney Int. 1998;53:1358–64.PubMedCrossRefGoogle Scholar
  32. 32.
    Lettgen B, Jeken C, Reiners C. Influence of steroid medication on bone mineral density in children with nephritic syndrome. Pediatr Nephrol. 1994;8:667–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Cayco AV, Wysolmerski J, Simpson C, Mitnick MA, Gundberg C, Kliger A, Lorber M, Silver D, Basadonna G, Friedman A, Insogna K, Cruz D, Bia M. Posttransplant bone disease: evidence for a high bone resorption state. Transplantation. 2000;70(12):1722–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Baserab A, Levin A. Defining a renal anemia management period. Am J Kidney Dis. 2000;36:S13–23.CrossRefGoogle Scholar
  35. 35.
    Akman S, Guven AG, Ince S, Yegin O. IgG and IgG subclasses deficiency in children undergoing continuous ambulatory peritoneal dialysis and its provocative factors. Pediatr Int. 2002;44(3):273–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Kim MS, Stablein D, Harmon WE. Renal transplantation in children with congenital nephrotic syndrome: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant. 1998;2(4):305–8.PubMedGoogle Scholar
  37. 37.
    Yinnon AM, Gabay D, Raveh D, Schlesinger Y, Slotki I, Attias D, Rudensky B. Comparison of peritoneal fluid culture results from adults and children undergoing CAPD. Perit Dial Int. 1999;19(l):51–5.PubMedGoogle Scholar
  38. 38.
    Kuizon B, Melocoton TL, Holloway M, Ingles S, He-Jing, Fonkalsrud EW, Salusky IB. Infectious and catheter-related complications in pediatric patients treated with peritoneal dialysis at a single institution. Pediatr Nephrol. 1995;9(Suppl):S12–17.PubMedCrossRefGoogle Scholar
  39. 39.
    Mathurin P, Mouquet C, Poynard T. Impact of hepatitis B and C virus on kidney transplantation outcomes. Hepatology. 1999;29:257–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Morales JM, Campistol JM. Transplantation in the patient with hepatitis C. J Am Soc Nephrol. 2000;11:1343–53.PubMedGoogle Scholar
  41. 41.
    Kirk AD, Heisey DM, D’Alessandro AM, Knechtle SJ, Odorico JS, Rayhill SC, Sollinger HW, Pirsch JD. Clinical hepatitis after transplantation of hepatitis C virus-positive kidneys: HLA-DR3 as a risk factor for the development of posttransplant hepatitis. Transplantation. 1996;62(12):1758–62.PubMedCrossRefGoogle Scholar
  42. 42.
    Bock GH, Sullivan EK, Miller D, Gimon D, Alexander S, Ellis E, Elshihabi I. Cytomegalovirus infections following renal transplantation-effects on antiviral prophylaxis: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1997;11(6):665–71.PubMedCrossRefGoogle Scholar
  43. 43.
    Srivastava T, Zwick DL, Rothberg PG, Warady BA. Posttransplant lymphoproliferative disorder in pediatric renal transplantation. Pediatr Nephrol. 1999;13(9):748–54.PubMedCrossRefGoogle Scholar
  44. 44.
    Salvatierra O, Tanney D, Mak R, Alfrey E, Lemley K, Mackie F, So S, Hammer G, Drane E, Conley S. Pediatric renal transplantation and its challenges. Transplant. Rev. 1997;11(2):51–69.CrossRefGoogle Scholar
  45. 45.
    Alfrey EJ, Salvatierra O, Tanney DC, Mak R, Scandling JD, Dafoe DC, Hammer GB, Orlandi PD, Page L, Conley S. Bladder augmentation can be problematic with renal failure and transplantation. Pediatr Nephrol. 1997;11:672–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Smith GHH, Canning DA, Schulman SL et al. The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol. 1996;155:1730.PubMedCrossRefGoogle Scholar
  47. 47.
    Salvatierra O, Sarwal M, Alexander S, Lemley K, Yorgin P, Al-Uzri A, Lu A, Millan M, Alfrey E. A new, unique and simple method for ureteral implantation in kidney recipients with small, defunctionalized bladders. Transplantation. 1999;68:731–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Serrano DP, Flechner SM, Modlin CS et al. Transplantation into the long-term defunctionalized bladder. J Urol. 1996;156:885.PubMedCrossRefGoogle Scholar
  49. 49.
    Connolly JA, Miller B, Bretan P. Renal transplantation in patients with posterior urethral valves: favorable long-term outcome. J Urol. 1995;154:1153.PubMedCrossRefGoogle Scholar
  50. 50.
    Salvatierra O. Urologic complications in renal transplantation. In: Tejani A, editor. Renal Transplantation. New York: Wiley-Liss, 1994: p. 337.Google Scholar
  51. 51.
    Bartsch LA, Sarwal M, Orlandi P, Yorgin PD, Salvatierra O. Limited surgical interventions in children with posterior urethral valves can lead to better outcomes following renal transplantation. Pediatr Transplant. 2002;6:400–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Elder JS, Snyder HM, Holbert WC, Duckett JW. Perforation of the augmented bladder in patients undergoing clean intermittent catheterization. J Urol. 1988;140:1159–62.PubMedGoogle Scholar
  53. 53.
    Rushton HG, Woodard JR, Parrot TS et al. Delayed bladder rupture following augmentation enterocystoplasty. J Urol. 1988;140:344–6.PubMedGoogle Scholar
  54. 54.
    Sheiner FR, Kaplan GW. Spontaneous bladder rupture following enterocystoplasty. J Urol. 1988;140:1157–8.PubMedGoogle Scholar
  55. 55.
    Rink RC, Woodbury PW, Mitchell ME. Bladder perforation following enterocystoplasty. J Urol. 1988;139:234A.Google Scholar
  56. 56.
    N’Dow J, Leung HY, Marshall C, Neal DE. Bowel dysfunction after bladder reconstruction. J Urol. 1998;159:1470–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Darby CR, Cranston D, Raine AE, Morris PJ. Bilateral nephrectomy before transplantation: indications, surgical approach, morbidity and mortality. Br J Surg. 1991;78(3):305–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Birkeland SA, Storm HH. Risk for tumor and other disease transmission by transplantation: a population-based study of unrecognized malignancies and other diseases in organ donors. Transplantation. 2002;74(10):1409–13.PubMedCrossRefGoogle Scholar
  59. 59.
    Cecka JM. The UNOS renal transplant registry. Clin Transpl. 2001;1–18.Google Scholar
  60. 60.
    Joseph JT, Kingsmore DB, Junor BJ, Briggs JD, Mun Woo Y, Jaques BC, Hamilton DN, Jardine AG, Jindal RM. The impact of late acute rejection after cadaveric kidney transplantation. Clin Transplant. 2001;15(4):221–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Terasaki PI. The HLA-matching effect in different cohorts of kidney transplant recipients. Clin Transpl. 2000;497–514.Google Scholar
  62. 62.
    Alarabi A, Backman U, Wikstrom B, Sjoberg O, Tufveson G. Plasmapheresis in HLA-immunosensitized patients prior to kidney transplantation. Int J Artif Organs. 1997;20(l):51–6.PubMedGoogle Scholar
  63. 63.
    Tyan DB, Li VA, Czer L, Trento A, Jordan SC. Intravenous immunoglobulin suppression of HLA alloantibody in highly sensitized transplant candidates and transplantation with a histoin-compatible organ. Transplantation. 57(4):553-62.Google Scholar
  64. 64.
    Haas M, Bohmig GA, Leko-Mohr Z, Exner M, Regele H, Derfler K, Horl WH, Druml W. Perioperative immunoadsorption in sensitized renal transplant recipients. Nephrol Dial Transplant. 2002;17(8):1503–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Bohmig GA, Regele H, Exner M, Derhartunian V, Kletzmayr J, Saemann MD, Horl WH, Druml W, Watschinger B. C4d-positive acute humoral renal allograft rejection: effective treatment by immunoadsorption. J Am Soc Nephrol. 2001;12(11):2482–9.PubMedGoogle Scholar
  66. 66.
    Schroeder TJ, First MR, Mansour ME, Alexander JW, Penn I. Prophylactic use of OKT3 in immunologic high-risk cadaver renal transplant recipients. Am J Kidney Dis. 1989;14 (5 Suppl 2):14–18.PubMedGoogle Scholar
  67. 67.
    Tilney NL, Guttmann RD. Effects of initial ischemia/reperfusion injury on the transplanted kidney. Transplantation. 1997;64:945.PubMedCrossRefGoogle Scholar
  68. 68.
    Ishitani M, Isaacs R, Norwood V, Nock S, Lobo P. Predictors of graft survival in pediatric living-related kidney transplant recipients. Transplantation. 2000;70(2):288–92.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • M. Sarwal
  • O. SalvatierraJr.

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