Outcomes After Pediatric Kidney Transplantation Improving: How Can We Do Even Better?

Abstract

Kidney transplant is the treatment of choice for children and adolescents with end-stage renal disease because transplantation improves quality of life and survival to a far greater extent than chronic dialysis.1 Unfortunately, however, transplantation does not completely normalize the excess risks associated with end-stage renal disease nor do transplanted allografts function indefinitely. In this issue of Pediatrics , Van Arendonk et al2 provide valuable information on national trends in outcomes among pediatric kidney transplant recipients. Over a 25-year period, the authors observed remarkable improvements in patient and allograft survival following kidney transplantation after accounting for many changes in donor and recipient characteristics. The greatest improvements for both patient and allograft survival were within the first year, highlighting the need for ongoing improvements in long-term outcomes. How will additional improvements in overall survival be achieved? The causes of death were not specified in the study by Van Arendonk et al,2 precluding greater insight into the reasons for improved survival. Whether improvements were related to reductions in cardiovascular causes, infection, or malignancy are not known but are important to better understand how … Address correspondence to Uptal D. Patel, MD, Duke Clinical Research Institute, 2400 Pratt St, Box 3646, Durham, NC 27705. E-mail: uptal.patel{at}duke.edu