Evolution of pediatric kidney transplantation: A single center experience
Vasiliy Bogdanov1, Igor Miloserdov1,2, Alexander Kartashev1, Dzhabrail Saidulaev1, Diana Khalikova3, Evgenia Kulikova3, Irina Pashkova3, Sergey Gautie1,2.
1Department of surgery, Shumakovs V. I. National Medical Research Center of Transplantology and Artifical Organs, Moscow, Russian Federation; 2Faculty of transplantology and artifical organs, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow Stat, Moscow, Russian Federation; 3Department of pediatry, Shumakovs V. I. National Medical Research Center of Transplantology and Artifical Organs, Moscow, Russian Federation
Introduction: For today, a successful renal transplantation is the optimal method of managing chronic kidney failure. Nevertheless, for a long time this method was not accessible for children due to a surgery technique imperfection and immunosuppressive drug therapy inefficiency. Over the last few decades, better understanding of the immune system and refining surgical technique allows to improve pediatric kidney transplant outcomes.
Objective: The National Medical Research Center of Transplantology and Artifical Organs is one of the most experienced clinics in pediatric kidney transplantation in Russian Federation. The objective of this article is to show the results of pediatric transplantation program in a single center.
Materials and Methods: We performed a retrospective cohort study of patients who underwent kidney transplantation from 2010 to 2019. All the patients were under 18 years old when they underwent kidney transplantation. Gender, age, cause of graft failure, early and late complications were collected. All provided data was processed using nonparametrized methods.
Results: From 2010 to 2019 in our center 133 pediatric kidney transplantations were performed – 69 transplantations for male recipients and 64 for female recipients. The quantity of kidney transplantations has gradually increased from 2010 to 2019 (see fig. 1).
The median of age was 9,9 years old. 51 kidney allografts (39%) were taken from a cadaver donor and 82 kidney allografts (61%) were taken from a related living donor.
Median of weight was 27kg (from 8,5kg to 65kg). 31 patient weighed less than 15kg. It is very significant, because it defines surgical approach. For patients under 15kg we used a midline laparotomy and performed a bilateral nephrectomy in order to create space for allograft. For patients weighed more than 15kg we used a classical surgical approach with hockey-stick incision. The necessity of ipsilateral nephrectomy was usually decided during operation.
During observation time 118 patients (88%) had an adequate graft function. 11 patients (9%) had graft dysfunction. Causes of graft dysfunction were chronic rejection (4 cases), nephrotic syndrome (2 cases), arterial thrombosis (2 cases) and other causes (3 cases). Only 4 patients (3% cases) had died during observation (1 cerebral oedema, 1 stroke, 1 disseminated infection and 1 unidentified cause).
Conclusion: Modern immunosuppressive drugs and massive surgical experience allows to perform pediatric kidney transplantation with no less effectiveness as for adult patients.
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