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pediatric kidney transplantation

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https://www.readbyqxmd.com/read/28810723/graft-survival-of-pediatric-kidney-transplant-recipients-selected-for-de-novo-steroid-avoidance-a-propensity-score-matched-study
#1
Edward J Nehus, Chunyan Liu, Bo Lu, Maurizio Macaluso, Mi-Ok Kim
Background: Steroid-avoidance protocols have gained popularity in pediatric kidney transplant recipients at low immunologic risk. The long-term safety of steroid avoidance in children with immunologic risk factors remains unknown. Methods: Pediatric kidney transplant recipients from 2004 to 2014 in the Organ Procurement and Transplantation Network database who received tacrolimus and mycophenolate immunosuppression were investigated. Propensity score matching was used to compare graft survival in 1624 children who received steroid avoidance with 1624 children who received steroid-based immunosuppression...
August 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28805300/the-kidney-allocation-system-does-not-appropriately-stratify-risk-of-pediatric-donor-kidneys-implications-for-pediatric-recipients
#2
S M Nazarian, A W Peng, B Duggirala, M Gupta, T Bittermann, S Amaral, M H Levine
Kidney Allocation System (KAS) was enacted in 2014 to improve graft utility, while facilitating transplantation of highly-sensitized patients and preserving pediatric access to high-quality kidneys. Central to this system is the Kidney Donor Profile Index (KDPI), a metric intended to predict transplant outcomes based on donor characteristics but derived using only adult donors. We posited that KAS had inadvertently altered the profile and quantity of kidneys made available to pediatric recipients. This question arose from our observation that most pediatric donors carry a KDPI over 35 and have therefore been rendered relatively inaccessible to pediatric recipients under KAS...
August 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28801937/in-situ-split-liver-splitting-under-extra-corporeal-membrane-oxygenation-in-brain-dead-donor
#3
Assalino Michela, Pietro Majno, Christian Toso, Thierry Berney, Raphaël Giraud, Philipp Dutkowski, Axel Andres, Barbara Wildhaber, Laure Elkrief
Hemodynamic instability is generally considered as a contraindication to liver splitting, in particular when using an in-situ technique. We describe the cases of two young donors with brain death in whom refractory cardiac arrest and hemodynamic instability were supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), allowing uneventful in situ splitting. Two adult and two pediatric liver recipients were successfully transplanted with immediate graft function. Favorable outcomes were also observed for the other transplanted organs, including one heart, two lungs and four kidneys...
August 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28795324/the-fgf23-klotho-axis-and-cardiac-tissue-doppler-imaging-in-pediatric-chronic-kidney-disease-a-prospective-cohort-study
#4
Ylva Tranæus Lindblad, Hannes Olauson, Georgios Vavilis, Ulf Hammar, Maria Herthelius, Jonas Axelsson, Peter Bárány
BACKGROUND: Chronic kidney disease-associated mineral bone disorder (CKD-MBD) is common in pediatric kidney disease patients and a risk factor for future cardiovascular disease (CVD). Fibroblast growth factor-23 (FGF23) and Klotho are novel key players in CKD-MBD, and has been suggested to be involved in the development of CVD. METHODS: This prospective cohort study included 74 pediatric patients; 31 with CKD (age range 0.8-18.8 years, glomerular filtration rate (GFR) range 9-68 mL/min/1...
August 9, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28795150/the-effects-of-tacrolimus-on-t-cell-proliferation-are-short-lived-a-pilot-analysis-of-immune-function-testing
#5
Benjamin L Laskin, Jing Jiao, H Jorge Baluarte, Sandra Amaral, Susan L Furth, Tatiana Akimova, Wayne W Hancock, Matthew H Levine, Peter P Reese, Ulf H Beier
BACKGROUND: Optimal immunosuppression after organ transplant should balance the risks of rejection, infection, and malignancy while minimizing barriers to adherence including frequent or time-sensitive dosing. There is currently no reliable immune function assay to directly measure the degree of immunosuppression after transplantation. METHODS: We developed an immune function assay to mea//sure T-cell proliferation after exposure to immunosuppression in vivo. We tested the assay in mice, and then piloted the approach using single time point samples, 11 pediatric kidney transplant recipients prescribed tacrolimus, mycophenolate, and prednisone 6 months to 5 years posttransplant, with no history of rejection, opportunistic infection, or cancer...
August 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28766066/outcome-of-kidney-transplantation-in-pediatric-patients-with-anca-associated-glomerulonephritis-a-single-center-experience
#6
Damien Noone, Rae S M Yeung, Diane Hebert
OBJECTIVES: Data on kidney transplant outcomes for pediatric patients with end-stage renal disease (ESRD) secondary to anti-neutrophil cytoplasmic antibody glomerulonephritis (ANCA GN), particularly granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), is limited. We describe our experience of kidney transplantation in pediatric ANCA GN patients. METHODS: We performed a retrospective review of patients with ANCA GN who developed ESRD and were transplanted at a single center between the years 2000 and 2014...
August 1, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28766021/acute-kidney-injury-after-pediatric-liver-transplantation-incidence-risk-factors-and-association-with-outcome
#7
Miho Hamada, Shino Matsukawa, Satoshi Shimizu, Shinichi Kai, Toshiyuki Mizota
PURPOSE: Data on the incidence of, risk factors for, and association with outcomes of acute kidney injury (AKI) after pediatric liver transplantation are scarce. We conducted a retrospective cohort study to determine the incidence of AKI after pediatric liver transplantation. In addition, we examined risk factors for AKI and association of AKI with outcomes. METHODS: This study included 156 children aged between 3 months and 18 years undergoing liver transplantation at Kyoto University Hospital...
August 1, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28762577/assessing-barriers-to-adherence-in-routine-clinical-care-for-pediatric-kidney-transplant-patients
#8
Charles D Varnell, Kristin L Rich, Melissa Nichols, Devesh Dahale, Jens W Goebel, Ahna L H Pai, David K Hooper, Avani C Modi
Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence...
August 1, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28760487/complications-of-therapeutic-apheresis-in-pediatric-kidney-transplantation
#9
REVIEW
Mattia Parolin, Enrico Vidal
In the setting of kidney transplantation, therapeutic apheresis (TA) is employed both for pre-intervention procedures and during the post-transplant period. In pediatric nephrology units, TA is usually performed as a therapeutic plasma exchange (TPE) with dialysis equipment, and using non-plasma replacement fluids. In children undergoing kidney transplantation, complications of TPE are mainly related to its depletive properties combined with the iatrogenic immunodeficiency status of the patient. Moreover, the use of small central venous catheters and the equipment standardized for adults can increase the risk of adverse events...
July 10, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28751095/a-comprehensive-review-of-immunization-practices-in-solid-organ-transplant-and-hematopoietic-stem-cell-transplant-recipients
#10
REVIEW
Pearlie P Chong, Robin K Avery
BACKGROUND: Vaccine-preventable diseases, especially influenza, varicella, herpes zoster, and invasive pneumococcal infections, continue to lead to significant morbidity and mortality in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. METHODS: We highlight guideline recommendations for the use of key vaccines in SOT and HSCT recipients and to review the latest evidence and developments in the field. RESULTS: Physicians should vaccinate individuals with end-stage organ disease, as vaccine seroresponse rates are higher pretransplantation...
July 24, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28750890/cost-analysis-of-substitutive-renal-therapies-in-children
#11
Maria Fernanda Carvalho de Camargo, Klenio de Souza Barbosa, Seiji Kumon Fetter, Ana Bastos, Luciana de Santis Feltran, Paulo Cesar Koch-Nogueira
OBJECTIVE: End-stage renal disease is a health problem that consumes public and private resources. This study aimed to identify the cost of hemodialysis (either daily or conventional hemodialysis) and transplantation in children and adolescents. METHODS: This was a retrospective cohort of pediatric patients with End-stage renal disease who underwent hemodialysis followed by kidney transplant. All costs incurred in the treatment were collected and the monthly total cost was calculated per patient and for each renal therapy...
July 24, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28744628/infection-related-hospitalizations-after-kidney-transplantation-in-children-incidence-risk-factors-and-cost
#12
Julien Hogan, Christine Pietrement, Anne-Laure Sellier-Leclerc, Ferielle Louillet, Rémi Salomon, Marie-Alice Macher, Etienne Berard, Cécile Couchoud
BACKGROUND: Infection is the leading cause of death and hospitalization in renal transplant recipients. We describe posttransplant infections requiring hospitalization, their risk factors and cost in a national pediatric kidney transplantation cohort. METHODS: Data on renal transplant recipients <20 years were extracted from the French National Medicoadministrative Hospital Discharge database between 2008 and 2013 and matched with the Renal Transplant Database...
July 25, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28736994/intraoperative-hemodynamic-factors-predicting-early-postoperative-renal-function-in-pediatric-kidney-transplantation
#13
Daphné Michelet, Christopher Brasher, Lucile Marsac, Nabil Zanoun, Mona Assefi, Alaa Elghoneimi, Stephane Dauger, Souhayl Dahmani
BACKGROUND: The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS: We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure...
September 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28735996/effect-of-hla-matching-on-pediatric-renal-transplant-graft-survival-in-china
#14
H Zhao, X Lai, J Lu, Y Lin, P Wang, L Zhu, L Wu, Z Xiao, Q Wang, J Tan
INTRODUCTION: Kidney transplantation (KTX) has become one of the most effective therapies of choice for pediatric patients with end-stage renal disease (ESRD). The extent to which HLA mismatching influences graft survival following KTX has not been clarified. PATIENTS AND METHODS: The effect of HLA amino acid residue matching on graft survival was assessed in 36 pediatric patients in whom complete donor-recipient HLA data were available. HLA-A, -B, -DR and HLA-A+B+DR loci residue mismatches were separately analyzed...
July 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28729907/current-status-of-pediatric-transplantation-in-japan
#15
REVIEW
Nao Nishimura, Mureo Kasahara, Kenji Ishikura, Satoshi Nakagawa
Brain-dead donor organ transplantation has been available to children in Japan since the 2010 revision of the Organ Transplant Law. Of the 50-60 brain-dead donor organ transplants performed annually in Japan, however, very few (0-4 per year) are performed in children. Again, while those receiving liver, heart, and kidney transplants are reported to fare better than their counterparts in the rest of the world, organ shortage is becoming a matter of great concern. Very few organs become available from brain-dead donors or are transplanted to adults if made available at all, with some children dying while on the brain-dead organ waiting list...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28727227/long-term-outcomes-of-simultaneous-heart-and-kidney-transplantation-in-pediatric-recipients
#16
Patricia L Weng, Juan Carlos Alejos, Nancy Halnon, Qiuheng Zhang, Elaine F Reed, Eileen Tsai Chambers
Pediatric sHKTx has become an effective therapy for patients with combined cardiac and renal failure. Often, these patients develop human leukocyte antigen antibodies from their previous allografts and are therefore more difficult to re-transplant. We describe the largest case series of a predominantly sensitized pediatric sHKTx with emphasis on medical management and patient outcomes. Demographics, clinical characteristics, antibody, and biopsy data were retrospectively collected from University of California, Los Angeles database and correlated with short- and long-term patient and allograft outcomes of all sHKTx performed between 2002 and 2015...
July 20, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28719391/pediatric-and-congenital-hand-transplantation
#17
Sandra Amaral, L Scott Levin
PURPOSE OF REVIEW: We review the approach and challenges associated with pediatric hand transplantation, including new knowledge gleaned from our recent case of bilateral hand-forearm transplantation in an 8-year old child. RECENT FINDINGS: Bilateral heterologous hand-forearm transplantation was performed in a child with a prior kidney transplant in July 2015. The initial surgery necessitated a large team of experts in microvascular surgery, transplant surgery, orthopedics and plastic surgery as well as pediatric anesthesia...
July 14, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28718192/cardiometabolic-risks-vary-by-weight-status-in-pediatric-kidney-and-liver-transplant-recipients-a-cross-sectional-single-center-study-in-the-usa
#18
S He, N A Le, J K Frediani, P D Winterberg, R Jin, R Liverman, A Hernandez, R L Cleeton, M B Vos
There is an increasing need to understand long-term metabolic changes and resultant comorbidities because life expectancy is increasing after pediatric kidney and liver transplants. We evaluated differences in classic and novel cardiometabolic biomarkers among obese and normal weight adolescent transplant recipients. We enrolled a total of 80 adolescent (mean±SD, 14.8 years ±3.0) transplant recipients (63 kidney, 17 liver) with mean duration from transplantation of 6.0 (±4.1) years. Among kidney transplant recipients, overweight and obese individuals had higher leptin (16...
July 17, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28717935/rabbit-anti-human-thymocyte-immunoglobulin-for-the-rescue-treatment-of-chronic-antibody-mediated-rejection-after-pediatric-kidney-transplantation
#19
Yasemen Cihan, Nele Kanzelmeyer, Jens Drube, Martin Kreuzer, Christian Lerch, Imke Hennies, Kerstin Froede, Murielle Verboom, Thurid Ahlenstiel-Grunow, Lars Pape
BACKGROUND: Chronic antibody-mediated rejection (cAMR) is the leading cause of late kidney graft loss, but current therapies are often ineffective. Rabbit anti-human thymocyte immunoglobulin (rATG) may be helpful, but its use is virtually undocumented. METHODS: Data were analyzed retrospectively from nine pediatric kidney transplant patients with cAMR were treated with rATG (1.5 mg/kg × 5 days) at our center after non-response to pulsed prednisolone, intravenous immunoglobulin, rituximab, and increased immunosuppressive intensity (including switching to belatacept in some cases), with or without bortezomib...
July 17, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28715116/delayed-transplantation-may-affect-intellectual-ability-in-children
#20
Jiwon M Lee, Yeon Kyung Jung, Jeong-Hoon Bae, Sun Ah Yoon, Ju Hee Kim, YoungRok Choi, Hyeyoung Kim, Kwang-Woong Lee, Hye Young Ahn, Jae Won Kim, Min-Sup Shin, Kyung-Suk Suh, Il-Soo Ha, Hae Il Cheong, Hee Gyung Kang, Nam-Joon Yi
BACKGROUND: Decline in neurocognitive function is a reported complication in children with chronic illness. Concerns have been increasing that exposure to a major surgery or trauma may negatively impact cognitive performance in children. This study has evaluated cognitive function in 43 Korean children who received organ transplantation, and sought to identify associated clinical factors. METHODS: Pediatric recipients of kidney (KT) or liver transplantation (LT) from years 1999 to 2011 were recruited for cognitive tests...
July 17, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
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