Pediatric Kidney Transplantation: Experience of a Center Over 4 Decades

Abstract

IntroductionChronic kidney disease in the pediatric population is associated with numerous comorbidities and an increased risk of mortality. Kidney transplantation (KT) is considered to be the option of choice in children with end-stage renal disease. AimTo characterize a single center experience in pediatric KT in the last 35 years. MethodsA retrospective analysis of epidemiologic and clinical data from KT pediatric patients from January 1981 to December 2016. For outcome analysis, cases were divided into decades (1981–89; 1990–99; 2000–09; 2010–16). ResultsOne hundred and 4 children (KT mean age 13.7 ± 3.32 years; 57.7% male) underwent 111 renal transplants (13% with living donors). Congenital anomalies of the kidney and urinary tract (36.5%) and glomerular disease (29%) were the major causes of renal disease. Peritoneal dialysis was the predominant initial therapeutic modality in 69 children (62.2%). Mean dialysis time was 19.2 months, 9 patients (8.1%) having had preemptive KT. Median follow-up was 181 months. Uncensored graft survivals rates at 5, 10, 15, and 20 years were 79.7%, 74.3%, 59.5%, and 52.8%, respectively. Graft survival improved significantly over the decades (P = .03). Higher estimated glomerular filtration rate measured at 1 year, induction immunosuppressive therapy use (thymoglobulin/basiliximab), and lower incidence of acute rejection rates were associated with superior graft survival (P < .05). ConclusionsUronephropathies were the most frequent cause of renal failure and peritoneal dialysis, which was the main renal replacement therapy according to the literature. Graft survival improved significantly over the study period; we hypothesize that this was related to surgical advances and the use of more effective immunosuppressive drugs.