Outcomes 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 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 chronic dialysis therapy in children, renal transplantation remains the best treatment for children with end-stage renal disease (ESRD) (figure 1). Over the last several years, renal allograft and patient survival have increased with improvements in the care of young patients and advances in immunosuppressive therapy. (See "Overview of renal replacement therapy (RRT) for children with chronic kidney disease", section on 'Choice of RRT'.)
Outcome of renal transplantation and the factors that affect allograft and patient survival in children will be reviewed here. General principles, immunosuppression, and complications of renal transplantation in children are discussed separately. In addition, issues of renal transplantation survival and outcome that are common to both children and adults are presented in separate topic reviews. (See "General principles of renal transplantation in children" and "Immunosuppression in renal transplantation in children" and "Complications of renal transplantation in children" and "Risk factors for graft failure in kidney transplantation" and "HLA matching and graft survival in kidney transplantation".)
RISK FACTORS FOR ALLOGRAFT SURVIVAL
The outcome of renal transplantation in children has improved over the last several decades [2,3]. This was illustrated in a study based on data from the United States Scientific Registry of Transplant Recipients (SRTR) that reported improvements of one-year graft survival for transplants performed in 1987 versus 2010 (81 versus 97 percent), five-year graft survival for transplants performed in 1987 versus 2006 (59 versus 78 percent), and 10-year graft survival for transplants performed in 1987 versus 2001 (47 versus 60 percent) . (See "Immunosuppression in renal transplantation in children" and 'Effect of immunosuppressive regimens' below.)
Factors that affect allograft survival in children include the following [4-8]:
●Improved immunosuppressive regimen
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- RISK FACTORS FOR ALLOGRAFT SURVIVAL
- Effect of immunosuppressive regimens
- Donor source
- HLA matches
- Recipient age
- Donor age
- Delayed graft function
- Acute rejection episodes
- PATIENT SURVIVAL
- GROWTH AFTER RENAL TRANSPLANTATION
- Age of recipient
- Allograft function
- Immunosuppressive therapy
- Donor source
- Growth hormone therapy