Long-Term Outcomes of Kidney Transplantation in Children

Abstract

Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD) in children and confers improved survival, skeletal growth, heath-related quality of life, and neuropsychological development compared with dialysis. Kidney transplantation in children with ESRD results in 10-year patient survival exceeding 90%. Therefore, the long-term management of these patients is focused on maintaining quality of life and minimizing long-term side effects of immunosuppression. Optimal management of pediatric kidney transplant recipients includes preventing rejection and infection, identifying and reducing the cardiovascular and metabolic effects of long-term immunosuppressive therapy, supporting normal growth and development, and managing a smooth transition into adulthood.

Keywords: Kidney transplantation; Outcomes; Pediatric.

Figure 1.. Epidemiology of pediatric kidney transplantation in the U.S.

(A) Causes of end-stage renal disease (ESRD) requiring dialysis or kidney transplant for children in the U.S. broken down by age group. C/H/C, congenital/hereditary/cystic disorders; GN, glomerulonephritis; CAKUT, Congenital anomalies of the kidney and urinary tract. Data from the United States Renal Data System (USRDS) 2017 Annual Data Report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive Kidney Diseases. (B) Recipients of living donor kidney transplant have superior graft survival compared to recipients of deceased donor transplant. Kidney graft survival at 3, 5, and 10 years is plotted by donor source and year transplanted. LD, Living Donor; DD, Deceased Donor. (C) Kidney graft survival by recipient age and donor source. Graft survival over 5 years is plotted for pediatric recipients <11 years and those age 11–17 years transplanted in the U.S. between 2006 and 2010. Data (B and C) from Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2015 Annual Data Report: Kidney. Am J Transplant. 2017;17 Suppl 1:21–116.

Figure 2.. Long-term outcomes of pediatric kidney transplant.

Issues facing pediatric kidney transplant recipients include those pertaining directly to the health of the allograft (e.g. rejection, recurrence), immune deficiency due to medications (e.g. viral infections, malignancy), growth and development in the context of organ failure (e.g. bone disease, transition to adulthood with chronic medical condition), and cardio-metabolic co-morbidities from immunosuppression (e.g. obesity, hypertension). Optimal care of the pediatric kidney transplant recipient addresses these issues in a multi-disciplinary fashion. CKD, chronic kidney disease; CMV, cytomegalovirus; EBV, Epstein Barr virus; BKV, BK polyoma virus; UTI, urinary tract infection; NODAT, new-onset diabetes after transplant.