General principles of renal transplantation in children
- Ruth A McDonald, MD
Ruth A McDonald, MD
- Professor of Pediatrics
- University of Washington
Once the estimated glomerular filtration rate (GFR) declines to less than 30 mL/min per 1.73 m2 and the child is in stage 4 chronic kidney disease, it is time to start preparing the child and the family for renal replacement therapy . Although there have been many advances in conservative renal replacement therapy, renal transplantation is the best treatment for children with end-stage renal disease (ESRD). This was shown in a study from Australia and New Zealand, in which the risk for death was more than four times higher with dialysis than with renal transplantation . Over the last several years, renal allograft and patient survival have increased due to improvements in the care of young patients and advances in immunosuppressive therapy, thereby resulting in reduced frequency and severity of acute rejection. (See "Overview of renal replacement therapy (RRT) for children with chronic kidney disease", section on 'Choice of RRT' and "Immunosuppression in renal transplantation in children".)
This topic will provide an overview of aspects of renal transplantation that should be considered in children. Immunosuppression, complications, and outcome of renal transplantation in children are presented separately. (See "Immunosuppression in renal transplantation in children" and "Complications of renal transplantation in children" and "Outcomes of renal transplantation in children".)
End-stage renal disease — The estimated incidence of end-stage renal disease (ESRD, chronic kidney disease [CKD] stage 5 defined as a glomerular filtration rate [GFR] <15 mL/min per 1.73 m2) in children varies throughout the world. It has been reported to be as high as 14.8 cases per million children in the United States and as low as four cases per million children below the age of 19 in Japan . In Europe, the incidence of renal replacement therapy varies greatly among countries, with a reported average incidence based on population-based studies of 5.5 cases per million children aged 0 to 14 years and 8.3 cases in children aged 0 to 19 years . The higher incidence in the United States may be explained by an earlier start on renal replacement therapy .
The renal diseases responsible for CKD in children are different from those observed in adult patients. For example, diabetic nephropathy and hypertension are rare causes of CKD in children but common in adults, whereas congenital renal and urologic anomalies are the most common cause of CKD in children.
The incidence and etiology of CKD are discussed in greater detail separately. (See "Epidemiology, etiology, and course of chronic kidney disease in children", section on 'Epidemiology' and "Epidemiology, etiology, and course of chronic kidney disease in children", section on 'Etiology'.)
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- End-stage renal disease
- Renal transplantation
- ADVANTAGES OF RENAL TRANSPLANTATION
- PREEMPTIVE TRANSPLANTATION
- DONOR CHOICE
- PRETRANSPLANT EVALUATION
- Detection and consequences of sensitization
- Urinary tract abnormalities
- Infectious disease issues
- Native nephrectomy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS