Pediatric Renal Transplant Research Articles

Ureteral Complications of Pediatric Renal Transplantation

PurposeUreteral complications following renal transplantation are more common in children than in adults. We identify potential risk factors for ureteral complications in pediatric patients. Materials and MethodsWe performed a retrospective cohort study of patients who underwent renal transplantation at Lurie Children’s Hospital between 2004 and 2016.The associations between patient characteristics, operative factors, graft characteristics and post-operative complications were analyzed. Resultsand Limitations: 224 renal transplantations in 219 patients were identified. Pre-existing bladder pathology was present in 25% of cases. The overall rate of ureteral complications was 16%, with symptomatic vesicoureteral reflux being the most common. Ureteral complications were significantly more common in patients with underlying bladder pathology (26% vs. 12%, p=0.01). The rate of post-operative vesicoureteral reflux in patients with bladder pathology was lower when a urologist performed the reimplantation, but this was not statistically significant (15% vs. 27%, p=0.35). Urologists were significantly more likely to perform the ureteral anastomosis in patients on clean intermittent catheterization (85% vs. 43%, p=0.004) and in patients with a history of complex bladder reconstruction (75% vs. 28%, p<0.001). ConclusionsPatients with existing bladder pathology are at a higher risk for ureteral complications, particularly vesicoureteral reflux. As pediatric urologists routinely perform ureteral reimplantation in patients with existing bladder pathology, these patients may benefit from a multidisciplinary approach between urology and transplant surgery at the time of renal transplantation

Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial.

Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far. In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8years, for whom ambulatory blood pressure monitoring (ABPM) data were available. In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change. Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

Abstract P394: Ace Activity and Its Expression as a Hypertension Biomarker in the Urine of Pediatric Renal Transplant Recipients

Pediatric hypertension is a risk factor for hypertension in adults. Primary hypertension results from genetic, environmental, and behavioral factors. Renin Angiotensin System is important to control cardiovascular and renal functions. Angiotensin Converting Enzyme (ACE) has isoforms: somatic (130-190 kDa) and testicular (90-110 kDa). Casarini et al. described the N-domain isoform of 90kDa, in urine of hypertensive humans as a possible hypertension biomarker. Objective: Analyze ACE isoform in urine of pediatric renal transplant recipients before and after transplantation and urine of donor, to verify the 90 kDa isoform transmission and correlating with hypertension. Methods: 30 pediatric recipients with living donors; ACE activity was performed before, 1, 3 and 6 months post transplantation using ZPhe and HHL as substrates and its ratio. Results: 69% had pre-transplant hypertension and 85.7% family history. After 6 months 25% remained. From the pre-transplant until the sixth month after, ACE activity was reduced. In the model of linear regression between ACE activity and variables, including pre-transplantation for the substrates ZPhe-HL remained significant, time and uropathy (0.023 more); with HHL, time and uropathy with higher activity of ACE (0.019 more) and for weight, reduction of ACE activity ( 0.00038 at 1 kg increase in weight). At post-transplant only time and weight remained significant with ZPhe-HL, and for HHL uropathy, proteinuria (0.010 more ACE activity) and weight. Recipients before transplantation had higher urinary ACE activity when compared to controls. Western blotting data showed that all recipients without ACE 90KDa when received a kidney from the donor that had this isoform, started to express it. Conclusions: Increased ACE activity in uropathies may be associated with renal injury or intra-renal production. Proteinuria, a marker of renal injury, can be associated with increase on ACE activity. With nutritional recovery and a healthy kidney after transplantation, patients can reverse the degree of renal damage and decrease the production of ACE.

P151 Eliminating false positive flow cytometric crossmatches due to monoclonal antibody therapy

Aim Biologics are increasingly used in autoimmune, cancer, and transplant patients. Unfortunately they can also interfere in laboratory tests. Monoclonal antibodies, such as Rituximab, are well known to cause positive flow cytometry crossmatches (FCM) independent of donor specific HLA antibody (DSA). We assessed the ability of blocking antibodies to Rituximab (RTX) and Alemtuzumab (ALM) to negate interference by these biologics in the FCM. Methods FCM was performed with serum from patients receiving RTX and/or ALM. Some sera were pretreated with anti-Rituximab ( α RTX) and/or anti-Alemtuzumab ( α ALM) blocking antibodies (Bio-Rad, Inc). HLA DSA was determined using multiplex bead arrays (LabScreen Single Antigen, Thermofisher, Inc.). FCM channel shifts (CS) were compared between treated sera and sera treated with PBS as a control. Results Blocking antibodies were titrated in serum to determine the working dilution to use in subsequent studies. Sera from patients receiving RTX and/or ALM were treated with the predetermined dilution of blocking antibody. Blocking antibody pre-treatment reduced FCM CS with surrogate donors to levels comparable to PBS controls: RTX blocking: pre-treatment CS = 23 T and 302 B; post-treatment CS = 35 T and 29 B; ALM blocking: pre-treatment CS = 262 T and 236 B; post-treatment CS = 34 T and 2 B. A highly sensitized (cPRA = 99%; DSA ;= B35, Cw4, DR17, DR52, DQ5) pediatric renal transplant candidate (RTX and ALM treated) was crossmatched with their living donor using pre-transplant and 4 day post-transplant (post-RTX and ALM treatment) sera. Post-treatment CS were increased without blocking but reduced with blocking antibody treatment. Blocked FCM CS results correlated better with reduced DSA MFI summed values in contrast to the unblocked serum (Table 1). Conclusions Antibodies to RTX and ALM effectively block interference by these biologics in FCM resulting in the ability to provide useful FCM data for patient management.

JC polyomavirus replication and associated disease in pediatric renal transplantation: an international CERTAIN Registry study.

JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce. Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3-8.1) years post-transplant. 53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p< 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p< 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p= 0.057). There was one male patient (0.7%) with JCPyVAN 7years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy. This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.

Differential profiles of adverse events associated with mycophenolate mofetil between adult and pediatric renal transplant patients.

ObjectiveImmunosuppressive regimens after renal transplantation usually include a combination of calcineurin inhibitors, corticosteroids, and a proliferation inhibitor, either azathioprine or mycophenolate mofetil (MMF), to prevent rejection and maintain graft function. MMF has a stronger immunosuppressive effect than does azathioprine. This study aimed to examine MMF-associated adverse events in renal transplant patients.MethodsRetrospective pharmacovigilance disproportionality analysis was conducted using the Japanese Adverse Drug Event Report database.ResultsA total of 11,594 adverse drug events were reported in renal transplant patients; 10,272 (88.6%) involved adults and 1322 (11.4%) involved children. In adult patients, the most frequent adverse events induced by MMF were cytomegalovirus infection (272 reports), urinary tract infection (69 reports), and polyomavirus-associated nephropathy (61 reports). Among adverse events, the highest reporting odds ratio (ROR) was found for cytomegalovirus infection (ROR, 1.58; 95% confidence interval, 1.36–1.83). In pediatric patients, the rank order for MMF-associated adverse events was cytomegalovirus infection (27 reports), bronchitis (23 reports), and cytomegalovirus viremia (19 reports), but these adverse events were not detected as a signal.ConclusionOur results show the safety profile of MMF in pediatric renal transplant patients. These findings can be used to update information used for prescriptions for pediatric patients.

Comparing treatment modalities for transplant kidney vesicoureteral reflux in the pediatric population

Non-refluxing ureteral reimplantation is favored in pediatric renal transplantation to prevent complications, such as vesicoureteral reflux (VUR) in the transplant ureter. VUR resulting in febrile urinary tract infections remains a problem in this population, leading to repeated hospitalizations and increased morbidity. Revision of the vesicoureteral anastomosis can be a surgical challenge due to scar tissue and tenuous vascularity of the transplant ureter. Therefore, alternative options such as endoscopic injection of Deflux at the neo-orifice and surveillance with prophylactic antibiotics have emerged as potential treatment modalities for transplant ureter VUR. The authors reviewed their experience of the management of VUR in the transplant ureter, comparing outcomes of various modalities. With Institutional Review Board approval, a retrospective chart review of all renal transplant patients from January 2002 to January 2017 was conducted. All patients with VUR on voiding cystourethrogram (VCUG) after surgery were identified. Indications for end-stage renal disease, urologic comorbidities, pretransplant VCUG, and operative details were recorded. After transplantation, febrile urinary tract infections, ultrasound findings, and any further interventions-surveillance, subureteral endoscopic injection of Deflux, or ureteral reimplantation-were documented along with their outcomes. Overall, VUR was identified in 35/285 (12.3%) transplant patients aftera non-refluxing ureteroneocystostomy. VUR was managed with surveillance in 17/35 (49%), intravesical Deflux injection in 11/35 (31%), and immediate redo ureteral reimplantation in 7/35 (20%). Ten out of 11 patients undergoing Deflux injection had a postoperative VCUG. All patients developed VUR recurrence; the majority showed immediate failure and only 1/10 showed late recurrence. Of the immediate failures, 3/9 patients were maintained on prophylactic antibiotics, and 6/9 patients underwent ureteral reimplantation. In these six patients undergoing reimplantation after failed Deflux, 3/6 (50%) patients required additional surgeries: One patient developed recurrence of reflux and two patients developed ureterovesical junction obstruction. In contrast, no complications were seen in patients undergoing primary ureteral reimplantation. The study is limited by low numbers and a retrospective design. However, the results of this study differ significantly from the published Deflux series showing a success rate of more than 50% in the treatment of transplant kidney VUR. In fact, post-Deflux redo ureteral reimplantation was associated with an increased risk of postoperative complication. The use of Deflux in the post-transplant setting has poor results. In the study series, 11/11 patients demonstrated clinical and radiographic failure. Therefore, as an institution the authors do not recommend Deflux as first-line treatment of VUR in the transplant patient.

Long-term outcome of pediatric renal transplantation in boys with posterior urethral valves

PurposeTo determine whether there is a difference in the outcome of renal transplantation (RT) in patients with posterior urethral valves (PUV) and children with non-uropathy related end stage renal disease. MethodsData were acquired retrospectively. We analyzed possible factors that influence the function of renal allografts and graft survival. Between 1995 and 2016 there were 149 RT. Out of them, there were 27 boys with PUV, who received 29 kidneys. Thirty patients, who received a total of 31 renal grafts due to a non-uropathic (NU) diagnosis, served as control group. Mean follow-up was 7.4 to 10.2 years. ResultsThere was no difference in estimated graft survival between patients with PUV and NU patients. Graft failure occurred in 23.1% of PUV patients and 34.5% patients of the NU group. There was no statistically significant disparity in graft function between the two groups. Age at transplantation and donor age were the only factors that had a significant impact on renal function. There was a higher incidence of UTI in the PUV group (96%) than in the NU group (67%). Vesicostomy was the favourable intervention in regards of graft function. ConclusionsRT in PUV patients is successful with the same outcome as in NU patients. Bladder dysfunction may not have a major impact on graft function and graft survival. It seems that the type of pre-transplant surgical procedures may influence outcome. Therefore, these interventions -if necessary- should be limited to a minimum. Type of StudyRetrospective Comparative Study Level of EvidenceLevel III

The Effects of Graft Weight on Allograft Outcomes in Pediatric Patients

Introduction Renal mass plays an important role for a balanced graft function after transplantation. Our aim is to evaluate the relation between transplanted renal mass and long term graft outcomes in pediatric renal transplant recipients. Materials and Methods Forty six children (M/F: 26/20) with kidney transplant from living related donor were enrolled to the study. Demographic data and laboratory findings were noted. The estimated glomerular filtration rate (eGFR) was calculated by Schwartz Formula. Grafts (Gw) and recipients (Rw) were weighed before transplantation. Patients were divided into three groups according to the Gw/Rw ratios (Gw/Rw<3.9 (P25), Gw/Rw=3.9-9.3 (P25-P75), Gw/Rw>9.3 (P75)). Relation between Gw/Rw ration and allograft outcomes was evaluated. Results Mean age at the time of the transplantation was 14.09±4.71 years. Mean age of donors (M/F:20/26) was 37.97±0.94 years. Mean follow-up time after transplantation was 3.87±1.08 years. Mean weight of recipients was 35.04±2.57 kg, mean weight of donors was 77.06±1.72 kg. Mean Gw/Rw ratio was 6.63±3.69. Delayed graft function was not observed. At 3rd years of follow-up, mean creatinine level was 0.89±0.26 mg/dl and mean GFR value was 97.07±16.86 ml/min. A statistically significant negative correlation was demonstrated between Gw/Rw ratio and creatinine levels at 3rd and 6th months and 1st and 3rd years of follow-up (r=-7.00, p<0.01, r=-7.28 p<0.01, r=-4.70 p<0.01, r=-5.86 p<0.05). Patients with Gw/Rw>9.3 had lowest mean creatinine levels during the first 6 months of transplantation when compared with patients with Gw/Rw ratio<3.9; but this difference between creatinine levels could not be demonstrated after 6th month of transplantation. Gw/Rw ratio was not associated with acute rejection episode and HLA mismatch. Gw/Rw ratio was not an independent risk factor for graft survival at 3rd year of follow-up in a multivariate logistic regression analysis. Conclusion We demonstrated a significant relation between renal mass and creatinine levels after transplantation. Pediatric renal transplantation from an adult donor is mostly results with higher Gw/Rw ratio. Higher Gw/Rw ratio can cause hyperfiltration during the first 6 months of transplantation, but it has no effect on long term outcomes.

Improved Diagnosis and Management of Paediatric Renal Transplant Recipients Using the Banff 2013 Histopathological Classification

Improved Diagnosis and Management of Paediatric Renal Transplant Recipients Using the Banff 2013 Histopathological Classification

Improved Renal Allograft Survival for Pre-Emptive Paediatric Renal Transplant Recipients in the United Kingdom

Improved Renal Allograft Survival for Pre-Emptive Paediatric Renal Transplant Recipients in the United Kingdom

Impact of MMP2, MMP9 and TIMP2 Gene Polymorphisms on Allograft Rejection in Pediatric Renal Transplant Recipients

Impact of MMP2, MMP9 and TIMP2 Gene Polymorphisms on Allograft Rejection in Pediatric Renal Transplant Recipients

Superior Renal Allograft Function with Male Deceased Donors for Paediatric Renal Transplant Recipients

Superior Renal Allograft Function with Male Deceased Donors for Paediatric Renal Transplant Recipients

The Rate of BK Virus Infection in Pediatric Renal Transplant Patients

The Rate of BK Virus Infection in Pediatric Renal Transplant Patients

Renal Blood Flow Measurements by Magnetic Resonance Imaging using Arterial Spin Labelling as a Novel Non-Invasive Biomarker in Paediatric Renal Transplant Recipients

Introduction To investigate our hypothesis that non-invasive cortical renal blood flow (cRBF) measurements using functional magnetic resonance imaging (MRI) arterial spin labelling (ASL) are sensitive biomarkers of early damage of the transplanted kidney in paediatric renal transplant recipients (pRTR). Methods Prospective study of pRTR undergoing MRI imaging using 1.5T Siemens Avanto system with multi-TI pulsed ASL acquisition performed at 10-20 days, 2 and 12 months with a FAIR labelling scheme and multi-shot 3D grase imaging module with background suppression. Results 14 pRTR (50% (7) male) aged 9.2-17.1 (median 13.2) years of whom 64% (9) had ESKD due to congenital anomalies of the kidneys and urinary tract underwent MRI ASL after transplantation (86% (12) living-related) with eGFR of 41.0-92.0 (median 60.9) mls/min/1.73m2 at follow-up of 3.5-5.4 (median 4.5) years. 46% (6) were pre-emptive transplants with 7% (1) re-transplanted. Patients had 0-5 (median 1) post-transplant UTI with 50% (7) EBV viraemia and underwent 1-7 (median 2) percutaneous renal transplant biopsies with evidence of steroid-resistant acute rejection episode due to non-adherence and borderline rejection in 7% (1) and 14% (2) pRTR respectively. Baseline MRI ASL at median 10 days showed cRBF of 86-268 (median 198) mls/100g/min with changes at subsequent and latest MRI performed at median 70 and 344 days respectively of -70 to +121 (median 52) and -56 to +147 (median 36) mls/100g/min respectively.Discussion Renal blood flow maximises in the first month after renal transplantation with subsequent reduction in first year in pRTR. There are multiple causes of renal allograft dysfunction in pRTR and associated risks in performing surveillance percutaneous renal transplant biopsies. MRI ASL is a useful and novel non-invasive biomarker of renal allograft function in pRTR.

Effects of Early Post-Transplant Blood Transfusion on Graft Outcome in Pediatric Renal Transplant Recipients

Introduction Anemia is commonly observed in early post-transplant period. Blood transfusion is the most frequent using procedure in correction of anemia. However early post transplant blood transfusions may increase immunological risks, antibody formation and rejection. There is little information on the impact of post-transplant transfusions in children. We aimed to evaluate effects of early post-transplant blood transfusion on graft outcome in pediatric renal transplant recipients Materials and Methods We retrospectively evaluated the data of 97 renal transplant patients. Demographic data of patients, etiology of renal failure, donor types, rejections, infections, and graft outcomes were recorded. We have documented all blood transfusions given within the first one month after transplantation. All transfused blood components were leuko-depleted. Data of patients with transfused and non-transfused were compared with respect of renal outcome. Results A total of 97 patients were included study (F/M:44/52). Mean transplant age of the patients was 14.43±4.76 years and the mean duration of follow-up was 48±12.76 months. Twenty two patients (22.6 %) had received a blood transfusion within the first month after transplantation. Transfused patients had significantly younger than non-transfused patients (9.1±3.2, 12.7±4.5 respectively, p<0.05). The median time for first blood transfusion was 2 days (0-30 days), the median number of transfusions was 1 (range:1-7) after renal transplantation. The indications of blood transfusions were acute hemorrhage, infections, and decreased Hemoglobin levels. The proportion of donor types, gender, HLA mismatch and immunosuppressive treatments were similar in both groups. Also, frequency of acute and chronic rejection, graft loss, PRA formation, first and third year GFR and graft survival were not significantly different (p>0.05) Conclusion Post transplant blood transfusions are common in children especially in young patients. Our study showed that early transfusions have no negative association with increased acute and chronic rejection, PRA production and graft loss. Further studies are needed for better evaluate the long-term risk of post-transplant blood transfusions in kidney recipients.

Genomic Changes in Pediatric Renal Transplant Patients Detected by aCGH

Introduction Acute and chronic allograft rejection are major problems in kidney transplantation. Identifying differences among individuals at the genomic level might help us to understand the rationale of tissue and organ rejection. The aim of this study is to identify the copy losses and gains in the genomes of patients experienced rejection in acute and chronic terms. Materials and Methods This study was designed as a retrospective single center study. A total of 24 pediatric renal transplant patients (F/M:10/14) were enrolled in the study. Patients were divided into 3 groups which are 8 kidney transplantation patients without rejection, 8 patients with acute rejection and 8 patients with chronic rejection. Agilent SurePrint G3 Human CGH 60K arrays were used to identify genome wide copy number variations. Results Mean transplant age of the non-rejection group, acute rejection, and chronic rejections patients were 15.8±4.2, 13.2±2.7, 16.4±3.8 years respectively. Average rejection time for acute and chronic rejection patients was 16.9±9.7 and 26.4±6.7 months, respectively. Results of the aCGH analysis showed that copy number losses were detected on chromosomes 1q42.2-q42.3, 2q13, 4q31.1, 7q11.23, 11q13.2, 14q11.2, 20q13.32, and copy number gains were detected on chromosomes 1p36.13, 1p32.3, 2p24.1, 2p21, 3q23, 5p13.2, 11q13.2, 12q24.21, 13q12.12, 16p11.2, 18p11.31, 19q13.43, 20p13, 20q11.21, 21q22.12, 21q22.2. Copy number variations were detected in patients with acute and chronic kidney rejection group but not in the non-rejection group. Discussion The management of acute and chronic allograft transplantation rejection is one of the major concerns during the follow up of transplantation patients. Nevertheless standardized protocols and well tuned immunosuppressant therapies are used in transplant patients; interindividual differences can cause different responses to drugs. In this study, we identified several genomic loci that show differences in terms of copy number state among patient groups. 18p11.31 is one of the loci identified in this study. TGIF1 gene within this region was reported to be over-expressed previously in kidney transplantation patients who experienced chronic rejection, which supports our finding that overexpression could be due to gain detected. Conclusion In this study, we identified copy number differences among kidney transplantation patients which might be important for the short and long term graft survival. Each region and genes within these regions could be individual possible biomarker to predict graft health.

Small effort, high impact: Focus on physical activity improves oxygen uptake (VO2peak ), quality of life, and mental health after pediatric renal transplantation.

This study estimates the effects on peak oxygen uptake (VO2 peak ), QoL, and mental health after the introduction of an adjusted post-transplant follow-up program, that is, early physiotherapy and focus on the importance of physical activity. VO2 peak was measured by a treadmill exercise test in 20 renal-transplanted children on the adjusted post-transplant follow-up and compared with a group of 22 patients investigated in a previously, before the implementation of our new follow-up routines. PedsQL and The Strengths and Difficulties Questionnaire (SDQ) were used to assess QoL and mental health in 45 patients on the new as compared to 32 patients on the previous follow-up strategy. The patients exposed to early physiotherapy and a higher focus on physical activity had significantly higher VO2 peak (44.3 vs 33.5mL kg-1 min-1 , P=.031) in addition to improved QoL (P=.003) and mental health scores (P=.012). The cardiovascular risk profile was similar in both groups aside from significantly higher triglycerides in the present cohort. Small efforts as early physiotherapy and increased focus on physical activity after pediatric renal transplantation have significant impact on cardiorespiratory fitness, QoL, and mental health. The importance of physical activity should therefore be emphasized in follow-up programs.

Pediatric Renal Transplantation: Evaluation of Long-Term Outcomes and Comparison to Adult Population

BackgroundIn Europe, pediatric transplantation accounts for only about 4% of all kidney transplantations performed. The aim of our work is to evaluate the evolution of pediatric renal transplantation in our department over time, but also to compare this special population with the adult one. MethodsWe evaluated all pediatric renal transplantations performed in our department between January 1981 and December 2016. We performed the analysis of clinical, analytical, and surgical factors to look for predictive factors of graft loss or decrease of survival. In addition, we performed a comparative study of pediatric and adult populations and an evaluation of the evolution of pediatric renal transplantation in our department over time. ResultsWe evaluated 101 renal transplantations performed in patients younger than 18 years. Pediatric transplantations corresponded to 3.4% of all renal transplantations performed in our department. The rate of living donors was 12%. Donors of grafts for the pediatric population were significantly younger than in the adult population. The increase in donor age was associated with lower renal graft survival rates. Acute rejections were more frequent in the pediatric population. Eleven pediatric recipients (10.9%) died in the follow-up period. Renal graft survival in the pediatric population was 94.8%, 77.4%, and 66.5% at 1, 5, and 10 years, respectively. There was no significant difference in graft survival in the pediatric and adult population. The pediatric overall survival rate at 1, 5 and 10 years was 97.9%, 96.8%, and 91.9%, respectively. ConclusionPediatric renal transplantation presents results identical to those identified in adults.

Abstract P-237: NEPHROLOGY CARE IN PEDIATRIC INTENSIVE CARE UNIT (PICU): EXPERIENCE OF PEDIATRIC NEPHROLOGY CENTRE OF HONG KONG

Aims & Objectives: To share our experience with renal support in intensive care settings in our nephrology centre. Methods Retrospective review. Results As the only tertiary referral center of pediatric nephrology in Hong Kong, as well as a regional tertiary center for PICU, from the year 1997–2017, we encountered more than hundreds of patients admitted to our PICU requiring renal support, with top diagnoses being 33 nephrotic syndrome, 25 systemic lupus erythematosus (SLE) and 21 hemolytic uremic syndrome (HUS). Nephrotic syndrome is often complicated by hypovolemic shock or acute renal failure requiring dialysis support. SLE can present as nephritis with renal failure, severe autoimmune hemolytic anemia or cerebral involvement. HUS in our locality is caused by pneumococcal pneumonia, which can lead to septic shock, pleural effusion, respiratory failure, and acute renal failure. Being the only pediatric renal transplant center in Hong Kong, we also managed 16 renal transplant cases admitted for post-operative care or transplant-related complications. We also encountered 12 severe peritonitis and 5 hypertensive encephalopathy. For procedures, continuous veno-venous hemofiltration (CVVH) (n= 17) remained the most important temporary renal replacement therapy for acute renal failure in intensive care setting. Recently we encountered a case of severe adenovirus pneumonia leading to secondary cardiopulmonary arrest with acute kidney injury. She was anuric post-resuscitation requiring CVVH for 41 days with eventual return of normal urine output and renal function. Plasmapheresis is another common procedure, which is useful for a wide range of conditions including toxic shock syndrome, HUS, SLE, inflammatory neurological conditions like Guillain-Barre etc. Conclusions As above.