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'.)
Subscribers log in hereLiterature review current through: Sep 2017. | This topic last updated: Sep 26, 2017.References
- National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1.
- McDonald SP, Craig JC, Australian and New Zealand Paediatric Nephrology Association. Long-term survival of children with end-stage renal disease. N Engl J Med 2004; 350:2654.
- Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol 2007; 22:1999.
- Chesnaye N, Bonthuis M, Schaefer F, et al. Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry. Pediatr Nephrol 2014; 29:2403.
- van Stralen KJ, Tizard EJ, Jager KJ, et al. Determinants of eGFR at start of renal replacement therapy in paediatric patients. Nephrol Dial Transplant 2010; 25:3325.
- Organ Procurement and Transplant Network; Data. Available from: http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp (Accessed on May 27, 2011).
- Stewart DE, Kucheryavaya AY, Klassen DK, et al. Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation. Am J Transplant 2016; 16:1834.
- North American Pediatric Renal Transplant Cooperative Study (NAPRTCS): 2010 Annual report. Rockville, MD. Available from: http://www.naprtcs.org (Accessed on May 27, 2011).
- Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant 2015; 15 Suppl 2:1.
- North American Pediatric Renal Trials and Collaborative Studies 2008 Annual report. https://web.emmes.com/study/ped/annlrept/Annual%20Report%20-2008.pdf (Accessed on June 09, 2011).
- Neu AM. Special issues in pediatric kidney transplantation. Adv Chronic Kidney Dis 2006; 13:62.
- Vats AN, Donaldson L, Fine RN, Chavers BM. Pretransplant dialysis status and outcome of renal transplantation in North American children: a NAPRTCS Study. North American Pediatric Renal Transplant Cooperative Study. Transplantation 2000; 69:1414.
- Kasiske BL, Snyder JJ, Matas AJ, et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 2002; 13:1358.
- Flom LS, Reisman EM, Donovan JM, et al. Favorable experience with pre-emptive renal transplantation in children. Pediatr Nephrol 1992; 6:258.
- Nevins TE, Danielson G. Prior dialysis does not affect the outcome of pediatric renal transplantation. Pediatr Nephrol 1991; 5:211.
- Cransberg K, Smits JM, Offner G, et al. Kidney transplantation without prior dialysis in children: the Eurotransplant experience. Am J Transplant 2006; 6:1858.
- Shishido S, Hasegawa A. Current status of ABO-incompatible kidney transplantation in children. Pediatr Transplant 2005; 9:148.
- Dale-Shall AW, Smith JM, McBride MA, et al. The relationship of donor source and age on short- and long-term allograft survival in pediatric renal transplantation. Pediatr Transplant 2009; 13:711.
- Harambat J, van Stralen KJ, Schaefer F, et al. Disparities in policies, practices and rates of pediatric kidney transplantation in Europe. Am J Transplant 2013; 13:2066.
- Baum MA, Stablein DM, Panzarino VM, et al. Loss of living donor renal allograft survival advantage in children with focal segmental glomerulosclerosis. Kidney Int 2001; 59:328.
- Churchill BM, Jayanthi RV, McLorie GA, Khoury AE. Pediatric renal transplantation into the abnormal urinary tract. Pediatr Nephrol 1996; 10:113.
- Krieger JN, Stubenbord WT, Vaughan ED Jr. Transplantation in children with end stage renal disease of urologic origin. J Urol 1980; 124:508.
- Warshaw BL, Edelbrock HH, Ettenger RB, et al. Renal transplantation in children with obstructive uropathy. J Urol 1980; 123:737.
- Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ 2005; 173:1181.
- Ghane Sharbaf F, Bitzan M, Szymanski KM, et al. Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatr Nephrol 2012; 27:1179.
- 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