Pediatric Kidney Transplantation

Abstract

Recently we achieved good outcomes in pediatric renal transplantation under basiliximab induction steroid withdrawal regimen including ciclosporin and mycophenolate mofetil (1 and 2 years patient/graft survival rates; 100%/96.6%). Steroid was withdrawn in 3 children and was given alternatively in 18 among 30 children under this regimen. Height standard deviation scores were significantly improved 1 year post-transplantation (-1.7+/-0.26 (mean+/-SE)), compared with those at transplantation (-2.1+/-0.23 (mean+/-SE)). Viral infection is still one of serious complications. Children tend to have symptomatic viral infection as a prime infection because of sero-negative antibodies against Cytomegalovirus (CMV) and Epstein-Barr virus(EBV). CMV was safely controlled with preemptive treatment monitoring with CMV antigenemia. EBV infection may result in posttransplant lymphoproliferative disease (PTLD). Ganciclovir for CMV and rituximab for EBV are useful. ABO blood group incompatible kidney transplantation demonstrated long-term better outcomes in children than adult. Pneumococcal infection was unexpectedly rare despite of splenectomy. Preemptive transplantation should be recommended to avoid dialysis for children regarding of good outcomes. Cadaver donor transplantation for a small child resulted in poor outcomes. Therefore living donor kidney transplantation for a small child is preferred. Management of cardiovascular monitoring with Swan-Ganz catheter and transesophageal ultrasound is important to overcome size mismatch between small body and a large kidney. It improves cardiac output and keeps good recirculation in an adult renal allograft. Kidney transplantation for children with end stage renal disease should be considered earlier and preemptively to improve growth retardation and provide better quality of life.