Kidney transplantation in pediatric and young adults: a single - center experience

Öz

Purpose: Pediatric kidney transplant (PKTx) is one of the most comfortable renal replacement therapies preferred in children with end-stage renal disease (ESRD) worldwide. Donor selection and identification of the underlying cause of renal failure in the recipient and individualisation of treatment are decisive factors for graft survival. The aim of this study is to present our results. Materials and methods: This single-center, retrospective study was conducted at Pamukkale University, Faculty of Medicine, Organ Transplantation Center. The PKTx was performed in 11 patients between December 2014 and November 2019. Results: The mean time from the beginning of the first dialysis session to transplantation was 40.2 months, and two patients were transplanted preemptively. The mean age of LD and DD transplants was 41.6 years and 17.1 years, respectively. This was attributed to the fact that, in the donation of cadaveric organs, donors under the age of 18 years are only registered for the waiting list for the recipients under the age of 18 years in our country. Conclusion: Our study showed that patients who used basiliximab for induction treatment were more advantageous in terms of infections than patients using anti-thymocyte globulin (ATG).

Anahtar Kelimeler

• Basiliximab
• ATG
• pediatric transplantation

Pediatrik ve genç erişkinlerde böbrek nakli: tek merkez deneyimi

Öz

Amaç: Pediatrik böbrek nakli, dünya çapında son dönem böbrek hastalığı (SDBY) olan çocuklarda tercih edilen en konforlu böbrek replasman tedavilerinden biridir. Donör seçimi ve alıcıda altta yatan böbrek yetmezliğine neden olan sebebin ortaya konması ve tedavinin bireyselleştirilmesi, greft sağkalımı için belirleyici faktörlerdir.ve Bu çalışmanın amacı elde ettiğimiz sonuçları sunmaktır. Gereç ve yöntem: Bu tek merkezli, retrospektif çalışma Pamukkale Üniversitesi Tıp Fakültesi Organ Nakil Merkezi'nde yapılmıştır. Pediatrik böbrek nakilleri, Aralık 2014 ile Kasım 2019 arasında 11 hastaya uygulandı. Bulgular: İlk diyaliz seansının başlangıcından transplantasyona kadar geçen ortalama süre 40,2 aydı ve iki hastaya önleyici olarak transplantasyon yapıldı. Canlı vericili ve kadavra vericili transplantlarının ortalama yaşı sırasıyla 41,6 ve 17,1 idi. Bu durum ülkemizde kadavra organ bağışında 18 yaş altı bağışçıların sadece 18 yaş altı bağışçıların bekleme listesine kaydedilmesine bağlanmıştır. Sonuç: Çalışmamız indüksiyon tedavisi için basiliximab kullanan hastaların anti-timosit globülin (ATG) kullanan hastalara göre enfeksiyon açısından daha avantajlı olduğunu göstermiştir.

Anahtar Kelimeler

• Basiliksimab
• ATG
• Pediatrik böbrek nakli

Kaynakça

1. 1. Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2016 annual data report: kidney. American Journal of Transplantation 2018:18-113. https://doi.org/10.1111/ajt.14557
2. 2. Cho MH. Pediatric kidney transplantation is different from adult kidney transplantation. Korean Journal of Pediatrics 2018;61:205-209. https://doi.org/10.3345/kjp.2018.61.7.205
3. 3. Simon DM, Levin S. Infectious complications of solid organ transplantations. Infectious Disease Clinics of North America 2001;15:521-549. https://doi.org/10.1016/s0891-5520(05)70158-6
4. 4. Galindo Sacristán P, Pérez Marfil A, Osorio Moratalla JM, et al. Predictive factors of infection in the first year after kidney transplantation. Transplantation Proceedings2013;45:3620-3623. https://doi.org/10.1016/j.transproceed.2013.11.009
5. 5. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatric Nephrology 2012;27:363-373. https://doi.org/10.1007/s00467-011-1939-1
6. 6. Wang K, Xu X, Fan M. Induction therapy of basiliximab versus antithymocyte globulin in renal allograft: a systematic review and meta-analysis. Clinical and Experimental Nephrology 2018;22:684-693. https://doi.org/10.1007/s10157-017-1480-z
7. 7. Acott PD, Lawen J, Lee S, Crocker JF. Basiliximab versus ATG/ALG induction in pediatric renal transplants: comparison of herpes virus profile and rejection rates. Transplantation Proceedings 2001;33:3180-3183. https://doi.org/10.1016/s0041-1345(01)02354-5
8. 8. Fishman JA, Emery V, Freeman R, et al. Cytomegalovirus in transplantation - challenging the status quo. Clinical Transplantation 2007;21:149-158. https://doi.org/10.1111/j.1399-0012.2006.00618.x

9. 9. Tang Y, Guo J, Li J, Zhou J, Mao X, Qiu T. Risk factors for cytomegalovirus infection and disease after kidney transplantation: a meta-analysis. Transplant Immunology 2022;74:101677. https://doi.org/10.1016/j.trim.2022.101677
10. 10. Agrawal A, Ison MG, Danziger Isakov L. Long-term infectious complications of kidney transplantation. Clin J Am Soc Nephrol. 2022;17:286-295. https://doi.org/10.2215/CJN.15971020
11. 11. Lebranchu Y, Bridoux F, Büchler M, et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. American Journal of Transplantation 2002;2:48-56. https://doi.org/10.1034/j.1600-6143.2002.020109.x
12. 12. De Wall LL, Oomen L, Glaap Roeven F, Feitz WF, Bootsma Robroeks CMHHT. Outcome of a thorough screening of lower urinary tract function in all pediatric kidney recipients. Pediatric Transplantation 2021;25:e13929. https://doi.org/10.1111/petr.13929
13. 13. Audard V, Amor M, Desvaux D, et al. Acute graft pyelonephritis: a potential cause of acute rejection in renal transplant. Transplantation 2005;80:1128-1130. https://doi.org/10.1097/01.tp.0000174343.05590.9f
14. 14. Naik AS, Dharnidharka VR, Schnitzler MA, et al. Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice. Transpl Int 2016;29:241-252. https://doi.org/10.1111/tri.12711
15. 15. Wu HY, Concepcion W, Grimm PC. When does vesicoureteral reflux in pediatric kidney transplant patients need treatment? Pediatric Transplantation 2018;22:e13299. https://doi.org/10.1111/petr.13299
16. 16. Sheth KR, White JT, Stanasel I, et al. Comparing treatment modalities for transplant kidney vesicoureteral reflux in the pediatric population. Journal of Pediatric Urology 2018;14:551-556. https://doi.org/10.1016/j.jpurol.2018.07.006