Pediatric Kidney Transplant Research Articles

Egyptian paediatric kidney transplantation pre-transplant guidance highlights on donor and recipient assessment (R. N. 364)

BackgroundKidney transplantation for chronic kidney disease (CKD) in children is the best treatment option. It needs special medical and surgical expertise highly skilled in management of pediatric age group. Our Egyptian profile for causes of end-stage renal failure (ESRF) in transplanted children reflects prevalence of inherited kidney diseases IKD (43%), urologic causes (26%), glomerulonephritis (GN) (17%), and unknown causes (14%). Renal graft availability remains a great challenge.AimWe need pediatric kidney transplantation (PKT) guideline since children have unique causes for ESRF compared to adults. Their transplant team should be skilled in management of children challenges. Recipients may not have one transplant per life. Long-standing immunosuppression will have its toxicity and need regular monitoring. Lots of data are extracted from adult guidelines lacking paediatric background. Young paediatric nephrologists need short version guidelines rich in educational figures for management plans. Children and their families need Arabic orientation booklets and supportive programmes. National Insurance System sponsors should be guided by National Pediatric Guidelines to minimize the centre’s variations.MethodsOur National Pediatric Guidelines are evidence based adapted from international four source guidelines with permissions [KDIGO-2020, RA/BTS 2022-2018, EAU 2018] that were appraised with Agree 2 plus tool using PIPOH format health questions. We followed the ‘adapted ADAPTE’ CPG formal adaptation methodology that consists of three phases and 24 steps and tools. It was registered on the practice guideline registration international guideline registry with a registration number IPGRP-2023-12-27 CN 312.ResultsSummary includes recommendations for assessment of (1) potential living adult donors for age, medical, surgical, immunologic, familial, metabolic, malignancy, and any donor morbidities and (2) transplant recipient assessment for age, weight, nutritional, psychosocial, immunological, infection states, primary native kidney disease, associated morbidities, the presence of genetic, immunologic, infection, and malignancy risks.ConclusionPediatric kidney transplantation guidelines aim for better donor, recipient, and graft survival. Recommendations are tailored as adopted or adapted statements from evidence-based source guidelines to suit our local pediatric CKD profile.

Haemodynamic effect of dexmedetomidine during paediatric kidney transplantation.

Dexmedetomidine is increasingly used for its ability to stabilise haemodynamic status during general anaesthesia. However, there is currently no data on paediatric kidney transplant recipients (pKTR). This study investigates the haemodynamic impact of dexmedetomidine administered perioperatively in pKTR. From 2019 to 2023, a retrospective study was conducted at Nantes University Hospital involving all pKTR under 18 years of age. The study compared intraoperative haemodynamic parameters between patients administered dexmedetomidine during kidney transplantation (DEX group) and those who did not receive it (no-DEX group). Mean arterial pressure (MAP) and heart rate (HR) were monitored throughout the duration of anaesthesia and compared. Graft function was assessed based on creatinine levels and glomerular filtration rate (GFR) at specific intervals. The perioperative use of fluids and vasoactive drugs, as well as their administration within 24 h post-surgery, were analysed. Thirty-eight patients were enrolled, 10 in the DEX group and 28 in the no-DEX group. Intraoperative HR was similar between the groups; however, MAP was higher in the DEX group (mean difference 9, standard deviation (SD, 1-11) mmHg, p = 0.039). No differences were found regarding the use of fluid and vasoactive drug therapy between groups. GFR at 1 month post-transplantation was significantly elevated in the DEX group (p = 0.009). pKTR receiving intraoperative dexmedetomidine exhibited higher perioperative MAP compared to those not administered dexmedetomidine. Additionally, the DEX group demonstrated superior graft function at 1 month. The direct impact of dexmedetomidine on immediate postoperative graft function in pTKR warrants further investigation in a prospective multicentre randomised study.

Effect of angiotensin II type 1 receptor antibodies on graft function and survival in paediatric kidney transplant recipients.

HLA donor specific antibodies (DSA) are implicated in antibody-mediated rejection (AMR), graft dysfunction and failure in kidney transplant (KT) recipients. Non-HLA antibodies including angiotensin II type 1 receptor (AT1R) may also play a role in AMR, impact graft function and survival. Data is limited in paediatric KT cohorts. We aimed to assess the prevalence and effect of pre-transplant AT1R antibodies on rejection, graft function and survival in paediatric KT recipients. This was a retrospective cohort study conducted across two paediatric centres including KT recipients with a pre-transplant AT1R antibody level. Outcomes included rejection, de novo DSA formation, graft function, failure, proteinuria and hypertension. Of 71 individuals, 72% recorded a positive pre-transplant AT1R Ab level (≥17 U/mL). Over a median follow-up of 4.7 years, AT1R Ab positivity demonstrated a trend towards increased risk of rejection however was not statistically significant (HR 3.45, 95% CI 0.97-12.35, p-value 0.06). Sensitivity analysis with AT1R Ab levels of ≥25 U/mL (HR 2.05 95% CI 0.78-5.39, p-value 0.14) and ≥40 U/mL (HR 1.32, CI 95% 0.55-3.17, p-value 0.53) validated this. De novo DSA formation occurred more frequently with AT1R Ab positivity (41% vs. 20%, p-value 0.9). AT1R Ab was not associated with hypertension, proteinuria, graft failure or dysfunction. In conclusion, this cohort study demonstrated a high prevalence of pre-transplant AT1R Ab positivity (72%). AT1R Ab positivity demonstrated a trend towards increased risk of rejection and de novo DSA formation however did not meet statistical significance. There was no association between AT1R Ab and hypertension, proteinuria, graft failure or dysfunction.

240.8: Pediatric kidney transplantation: A single center experience of 988 transplants from a low-income country.

240.8: Pediatric kidney transplantation: A single center experience of 988 transplants from a low-income country.

365.3: Pediatric kidney transplantation with deceased donors: A 10-year pioneering experience of hypothermic machine perfusion in Latin America.

365.3: Pediatric kidney transplantation with deceased donors: A 10-year pioneering experience of hypothermic machine perfusion in Latin America.

Long-term impact of immigration status on outcomes in pediatric kidney transplant recipients

This study aimed to investigate the effects of documentation status on pediatric kidney transplant outcomes in a single-center setting, emphasizing the significance of state insurance access for undocumented patients and federal policies like Deferred Action for Childhood Arrivals (DACA) on patient outcomes. A cohort of 283 patients, including 48 undocumented individuals, who received their first kidney transplant as children between 1998 and 2011 was analyzed. There was no significant difference in unadjusted all-cause (P = .91) and death-censored (P = .38) graft survival between undocumented patients and patients with permanent legal status, subsequently referred to as US residents. Additionally, in the Cox proportional hazards model, immigration status was not significantly associated with all-cause graft survival (hazard ratio 0.87, 95% CI 0.51-1.46, P = .6). Telephone interviews were conducted with the undocumented cohort. Forty-one of 48 of the undocumented recipients were contacted. Ninety-five percent had access to insurance with 68.3% on Medicaid or Medicare. DACA recipients exhibited higher employment rates (88% vs 67%, P = .11) and were more likely to complete a degree beyond high school (47.1% vs 12.5%, P = .01). Immigration status did not impact long-term graft survival, suggesting eligibility expansions for state-funded insurance and DACA may improve access to transplant care for undocumented patients. Moreover, DACA recipients showed trends toward increased employment and education compared to non-DACA recipients.

P.489: Pediatric kidney transplant and external urinary diversion in a patient with IVC thrombosis and abnormal urinary bladder: A case report.

P.489: Pediatric kidney transplant and external urinary diversion in a patient with IVC thrombosis and abnormal urinary bladder: A case report.

365.11: Pediatric kidney transplantation in Dubai. Outcomes and challenges.

365.11: Pediatric kidney transplantation in Dubai. Outcomes and challenges.

204.2: Pediatric kidney transplantation in infants and low-weight children: What have we learned so far?.

204.2: Pediatric kidney transplantation in infants and low-weight children: What have we learned so far?.

P.194: Pediatric kidney transplantation in under-resourced country: A single center experience.

P.194: Pediatric kidney transplantation in under-resourced country: A single center experience.

204.5: Pediatric kidney transplantation in the Middle East: Challenges and solutions.

204.5: Pediatric kidney transplantation in the Middle East: Challenges and solutions.

P.246: Long-term outcome following pediatric kidney transplantation is similar to adult kidney transplantation.

P.246: Long-term outcome following pediatric kidney transplantation is similar to adult kidney transplantation.

P.174: Factors associated with antibody mediated rejection in pediatric kidney transplantation.

P.174: Factors associated with antibody mediated rejection in pediatric kidney transplantation.

P.150: Viral infections in pediatric kidney transplant recipients: Impact on graft function, risk factors, and patient outcomes.

P.150: Viral infections in pediatric kidney transplant recipients: Impact on graft function, risk factors, and patient outcomes.

HLA tailored immunosuppression in living related pediatric kidney transplants in a low-income country. Cost and survival benefits

HLA tailored immunosuppression in living related pediatric kidney transplants in a low-income country. Cost and survival benefits

Age-Related Differences in Rejection Rates, Infections, and Tacrolimus Exposure in Pediatric Kidney Transplant Recipients in the CERTAIN Registry

IntroductionData on age-related differences in rejection rates, infectious episodes and tacrolimus exposure in pediatric kidney transplant recipients (pKTR) on a tacrolimus-based immunosuppressive regimen are scarce. MethodsWe performed a large-scale analysis of 802 pKTR from the CERTAIN registry from 40 centers in 14 countries. Inclusion criteria were a tacrolimus-based immunosuppressive regimen and at least two years of follow-up. The patient population was divided into three age groups (infants and young children <6 years, school-aged children 6-12 years, and adolescents >12 years) to assess age-related differences in outcome. ResultsMedian follow-up was 48 months (IQR, 36-72). Within the first 2 years post-transplant, infants and young children had a significantly higher incidence of infections (80.6% vs. 55.0% in adolescents, P<0.001) and a significantly higher number of cumulative hospital days (median 13 days vs. 7 days in adolescents, P < 0.001). Adolescents had a significantly higher rate of biopsy-proven acute rejection episodes in the first year post-transplant (21.7%) than infants and young children (12.6%, P=0.007). Infants and young children had significantly lower tacrolimus trough levels, lower tacrolimus concentration-to-dose ratios as an approximation for higher tacrolimus clearance, and higher tacrolimus intra-patient variability (all P < 0.01) than adolescents. ConclusionsThis largest study to date in European pKTR on a tacrolimus-based immunosuppressive regimen shows important age-related differences in rejection rates, infection episodes, tacrolimus exposure and clearance. These data suggest that immunosuppressive therapy in pKTR should be tailored and personalized according to the age-specific risk profiles of this heterogeneous patient population. The data may also serve as a benchmark for future studies with novel immunosuppressive drugs.

365.2: The clinical efficacy and safety of Rituximab in pediatric kidney transplant recipients with refractory epstein-barr virus: A case-control study.

365.2: The clinical efficacy and safety of Rituximab in pediatric kidney transplant recipients with refractory epstein-barr virus: A case-control study.

V-310.1: New prospective multicenter pOKRA study: Diagnosing allograft rejection and linking donor-derived cell-free DNA to interstitial fibrosis and cortical atrophy severity in pediatric kidney transplant rejection.

V-310.1: New prospective multicenter pOKRA study: Diagnosing allograft rejection and linking donor-derived cell-free DNA to interstitial fibrosis and cortical atrophy severity in pediatric kidney transplant rejection.

P.279: Is native nephrectomy almost a must in low-weight pediatric kidney transplant patients?

P.279: Is native nephrectomy almost a must in low-weight pediatric kidney transplant patients?

220.9: Long-term outcome of pediatric kidney transplant recipients: A single-center experience.

220.9: Long-term outcome of pediatric kidney transplant recipients: A single-center experience.