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pediatric kidney transplantation

Amber O Molnar, Louise Moist, Scott Klarenbach, Jean-Philippe Lafrance, S Joseph Kim, Karthik Tennankore, Jeffrey Perl, Joanne Kappel, Michael Terner, Jagbir Gill, Manish M Sood
Background: Hospitalizations of chronic dialysis patients have not been previously studied at a national level in Canada. Understanding the scope and variables associated with hospitalizations will inform measures for improvement. Objective: To describe the risk of all-cause and infection-related hospitalizations in patients on dialysis. Design: Retrospective cohort study using health care administrative databases. Setting: Provinces and territories across Canada (excluding Manitoba and Quebec)...
2018: Canadian Journal of Kidney Health and Disease
Eva Tschiedel, Roland Assert, Ursula Felderhoff-Müser, Simone Kathemann, Oliver Witzke, Peter Hoyer, Christian Dohna-Schwake
INTRODUCTION AND AIM: Procalcitonin is widely used as a biomarker to distinguish bacterial infections from other etiologies of systemic inflammation. Little is known about its value in acute liver injury resulting from intoxication with paracetamol. MATERIAL AND METHODS: We performed a single-center retrospective analysis of the procalcitonin level, liver synthesis, liver cell damage and renal function of patients admitted with paracetamol-induced liver injury to a tertiary care children's hospital...
July 2018: Annals of Hepatology
Corentin Tanné, Pascal Roy, Émilie Frobert, Anita Duncan, Audrey Laurent, Pierre Cochat
Cytomegalovirus is common in adult recipients (prevalence of 40-90%). Children are typically seronegative but immunosuppression may prone to primary-infection or viral reactivation, with potentially severe consequences. CMV infection incidence in pediatric kidney transplant recipients has seldom been investigated. The aim of our study was to evaluate the incidence and timing of CMV infection during the first year after renal transplantation. We assembled a retrospective cohort of 136 children who had received a kidney transplant between 2003 and 2014 with a year follow-up...
June 7, 2018: Néphrologie & Thérapeutique
A P Cazzolla, K Zhurakivska, D Ciavarella, M G Lacaita, G Favia, N F Testa, G Marzo, V La Carbonara, G Troiano, L Lo Muzio
AIMS: The aim of this study is to report the case of the orthodontic treatment in a patient affected by primary hyperoxaluria type 1 and subjected to a combinate liver-kidney transplant. METHODS AND RESULTS: The 9-year patient was admitted to our department for the presence of facial dysmorphism. The patient was affected by primary hyperoxaluria type 1 and has undergone a combined liver-kidney transplantation. At the time of the visit, he was in treatment with immunosuppressive drugs and received a corticosteroid and an antibiotic therapy monthly...
June 8, 2018: Special Care in Dentistry
H Antunes, B Parada, E Tavares-da-Silva, J Carvalho, C Bastos, A Roseiro, P Nunes, A Figueiredo
BACKGROUND: In 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. METHODS: We 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...
June 2018: Transplantation Proceedings
Rachel M Engen, Giulia E Park, Cooper S Schumacher, Idoia Gimferrer, Paul Warner, Laura S Finn, Noel S Weiss, Jodi M Smith
INTRODUCTION: The development of de novo donor-specific antibodies (dnDSA) has been associated with rejection and graft loss in kidney transplantation, and DSA screening is now recommended in all kidney transplant recipients. However, the clinical significance of dnDSA detected by screening patients with a stable creatinine remains unclear. METHODS: 103 patients <18 years old receiving a first, kidney alone transplant between 12/1/2007 and 12/31/2013 underwent DSA screening every 3 months for 2 years posttransplant, with additional testing as clinically indicated...
May 31, 2018: Transplantation
Reham Almardini, Ghazi Salaita, Jawaher Albderat, Katiba Alrabadi, Aghadir Alhadidi, Mahdi Alfarah, Ala' Abu Ruqa'a, Dina Dahabreh
OBJECTIVES: Kidney transplant is the best renal replacement therapy for pediatric patients with end-stage renal disease; however, this procedure is not without complications. A major complication is the development of new-onset diabetes mellitus, which affects the outcomes of transplant in terms of kidney and patient survival. In this study, our objective was to calculate the percentage of pediatric patients who developed new-onset diabetes mellitus or transient hyperglycemia after kidney transplant, compare our data with international data, and discuss the related factors that predispose to diabetes...
June 1, 2018: Experimental and Clinical Transplantation
Darren Lee, John B Whitlam, Natasha Cook, Amanda M Walker, Matthew A Roberts, Francesco L Ierino, Joshua Y Kausman
Living kidney donors (LKD) for pediatric kidney transplant recipients (KTR) have a heightened motivation to donate for emotional reasons and the clear health benefits to the KTR. We hypothesized that the cohort of LKD for pediatric KTR (LKD-P) includes motivated young parents with a higher lifetime end-stage kidney disease (ESKD) risk compared to adult KTR (LKD-A). Data from the Australia and New Zealand Dialysis and Transplant LKD Registry (2004-2015) was analysed to compare baseline characteristics and pre-donation ESKD risk in LKD-P (n=315) versus LKD-A (n=3448)...
May 30, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Stephan Ruben, Martin Kreuzer, Anja Büscher, Rainer Büscher, Julia Thumfart, Uwe Querfeld, Hagen Staude, Thurid Ahlenstiel-Grunow, Anette Melk, Dagmar-Christiane Fischer, Maren Leifheit-Nestler, Lars Pape, Dieter Haffner
BACKGROUND/AIMS: Whether the immunosuppressive regimen is associated with micro- and macro-vascular status in pediatric kidney transplant recipients (KTx) is unknown. METHODS: We performed a cross-sectional, case-control study in 44 pediatric KTx patients on either everolimus (EVR) plus calcineurin inhibitor or standard treatment, i.e. mycophenolate mofetil plus calcineurin inhibitor. Measurement of carotid intima-media thickness (cIMT) via ultrasound, central pulse wave velocity (PWV) by a cuff-based oscillometric technique, and skin microvascular blood flow during local heating via laser-Doppler-fluximetry (LDF) served as marker of subclinical vascular disease...
May 22, 2018: Kidney & Blood Pressure Research
Nicholas Mitrou, Shahid Aquil, Marie Dion, Vivian McAlister, Alp Sener, Patrick P Luke
Few transplant programs use kidneys from donors with body weight (BW) <10 kg. We hypothesized that pediatric en bloc transplants from donors with BW <10 kg, would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N=28). Data were stratified by smaller (donor BW less than 10 kg) (N=11) or larger donors (BW greater than 10 kg) (N=17). Renal volume was assessed during follow-up by ultrasound. Demographic characteristics were similar between the two groups of recipients...
May 24, 2018: American Journal of Transplantation
Motoshi Hattori, Makiko Mieno, Seiichiro Shishido, Atsushi Aikawa, Hidetaka Ushigome, Shinichi Ohshima, Kota Takahashi, Akira Hasegawa
BACKGROUND: Extensive data have been accumulated for adults who have undergone ABO-incompatible (ABOi)-living kidney transplantation (LKT). In contrast, available published data on pediatric recipients who underwent ABOi-LKT from the early to middle 2000s is very limited. Thus, pediatric ABOi-LKT has remained relatively rare and there is a lack of large, multicenter data. METHODS: We analyzed data from the Japanese Kidney Transplant Registry to clarify the patient and graft outcomes of pediatric recipients who underwent ABOi-LKT from 2002 to 2015...
April 30, 2018: Transplantation
Michael E Seifert, Megan V Yanik, Daniel I Feig, Vera Hauptfeld-Dolejsek, Elizabeth C Mroczek-Musulman, David R Kelly, Frida Rosenblum, Roslyn B Mannon
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤ 6 months post-transplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure...
May 15, 2018: American Journal of Transplantation
Rachel M Engen, Meei-Li Huang, Giulia E Park, Jodi M Smith, Ajit P Limaye
BACKGROUND: Adenovirus infection is associated with graft dysfunction and graft loss in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. METHODS: We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. RESULTS: Adenovirus viremia was detected in 11 (14...
May 2, 2018: Transplantation
D E Stewart, A R Wilk, A E Toll, A M Harper, R R Lehman, A M Robinson, S A Noreen, E B Edwards, D K Klassen
The OPTN monitors progress toward strategic goals such as increasing the number of transplants and improving waitlisted patient, living donor, and transplant recipient outcomes. However, a methodology for assessing system performance in providing equity in access to transplants was lacking. We present a novel approach for quantifying the degree of disparity in access to deceased donor kidney transplants among waitlisted patients and determine which factors are most associated with disparities. A Poisson rate regression model was built for each of 29 quarterly, period-prevalent cohorts (1/1/10-3/31/17; 5 years pre-KAS, 2 years post-KAS) of active kidney waiting list registrations...
May 7, 2018: American Journal of Transplantation
Claire Mockler, Atul Sharma, Ian W Gibson, Ang Gao, Alexander Wong, Julie Ho, Tom D Blydt-Hansen
Pediatric kidney transplantation is lifesaving, but long-term allograft survival is still limited by injury processes mediated by alloimmune inflammation that may otherwise be clinically silent. Chemokines associated with alloimmune inflammation may offer prognostic value early post-transplant by identifying patients at increased risk of poor graft outcomes. We conducted a single-center prospective cohort study of consecutive pediatric kidney transplant recipients (<19 years). Urinary CCL2 and CXCL10 measured at 6 months post-transplant were evaluated for association with long-term eGFR decline, allograft survival, and concomitant acute cellular rejection histology...
May 7, 2018: Pediatric Transplantation
Christoph Troppmann, Chandrasekar Santhanakrishnan, Ghaneh Fananapazir, Kathrin Troppmann, Richard Perez
En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent owing to the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs. 65 donation after brain death [DBD] transplants; pair-matched for: donor weight and terminal creatinine; preservation time). For DCD vs. DBD, median donor weight was 5.0 vs. 5.0 kg; median recipient age 57 vs. 48 years (p=0.006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (p=0...
May 2, 2018: American Journal of Transplantation
Christine M Mincham, Ian W Gibson, Atul Sharma, Chris Wiebe, Rupasri Mandal, David Rush, Peter Nickerson, Julie Ho, David S Wishart, Tom D Blydt-Hansen
Urinary CXCL10 and metabolites are biomarkers independently associated with TCMR. We sought to test whether these biomarkers fluctuate in association with histological severity of TCMR over short time frames. Forty-nine pairs of renal biopsies obtained 1-3 months apart from 40 pediatric renal transplant recipients were each scored for TCMR acuity score (i + t; Banff criteria). Urinary CXCL10:Cr and TCMR MDS were obtained at each biopsy and were tested for association with changes between biopsies in acuity, estimated GFR (ΔeGFR), and 12-month ΔeGFR...
April 25, 2018: Pediatric Transplantation
Yamei Jiang, Turun Song, Yang Qiu, Jinpeng Liu, Zhiling Wang, Xianding Wang, Zhongli Huang, Yu Fan, Li Wang, Tao Lin
Kidneys from pDDs are increasingly used to narrow the huge gap between incremental demand and static supply. However, there is still controversy on the clinical outcome of SKT from pDDs. We conducted a retrospective cohort study of 452 adult recipients in our center between March 2012 and February 2017. Outcomes of 3 groups, transplants with organs from pDDs (n=50), aDDs (n=207), and LDs (n=195), were compared. The mean age and weight of pDDs were 8.98 years (range 8 months-17 years) and 30.05 kg (range 8...
April 25, 2018: Pediatric Transplantation
Thomas G Fox, Corina Nailescu
Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians...
April 18, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Verena Klämbt, Marcus Panning, Maximilian Seidl, Karsten Häffner, Martin Pohl
HEV infection can lead to chronic hepatitis in immunosuppressed patients; extrahepatic manifestations are rarely seen. Here, we report a 13-year-old renal transplant patient with chronic hepatitis E and renal involvement. Ribavirin therapy led to temporary virus clearance and amelioration of kidney function. However, ribavirin therapy caused severe hyporegenerative anemia, which has so far only been reported in patients treated with a combination of ribavirin and interferon alpha.
June 2018: Pediatric Transplantation
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