Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study. (19th January 2018)

• Record Type: Journal Article
• Authors: Chiodini, Benedetta; Herman, Jean; Lolin, Ksenija; Adams, Brigitte; Hennaut, Elise; Lingier, Pierre; Mikhalski, Dimitri; Schurmans, Thierry; Knops, Noël; Wissing, Karl M.; Abramowicz, Daniel; Ismaili, Khalid
• Is Part Of: Transplant international. Volume 31:Number 7(2018)
• Page Start: 720
• Page End: 728
• Publication Date: 2018-01-19
• Subjects: acute rejections -- graft survival -- kidney transplantation -- patient survival -- pediatric -- small children; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13108
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Kidney transplantation (KT) is often delayed in small children because of fear of postoperative complications. We report early‐ and long‐term outcomes in children transplanted at ≤15 kg in the two largest Belgian pediatric transplant centers. Outcomes before (period 1) and since the introduction of basiliximab and mycophenolate‐mofetil in 2000 (period 2) were compared. Seventy‐two KTs were realized between 1978 and 2016: 38 in period 1 and 34 in period 2. Organs came from deceased donors in 48 (67%) cases. Surgical complications occurred in 25 KTs (35%) with no significant difference between the two periods. At least one acute rejection (AR) occurred in 24 (33%) KTs with significantly less patients experiencing AR during period 2: 53% and 12% in period 1 and, period 2 respectively ( P < 0.001). Graft survival free of AR improved significantly in period 2 compared with period 1: 97% vs. 50% at 1 year; 87% vs. 50% at 10 years post‐KT ( P = 0.003). Graft survival tended to increase over time (period 1: 74% and 63% at 1 and 5 years; period 2: 94% and 86% at 1 and 5 years; P = 0.07), as well as patient survival. Kidney transplantation in children ≤15 kg remains a challenging procedure with 35% of surgical complications. However, outcomes improved and are nowadays excellent in terms of prevention of AR, patient and graft survival.