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Review
. 2022 Apr 1;34(2):234-240.
doi: 10.1097/MOP.0000000000001100.

Kidney transplantation in pediatric patients with rheumatologic disorders

Ellen Cody  1 , David K Hooper  2
Affiliations
Review

Kidney transplantation in pediatric patients with rheumatologic disorders

Ellen Cody et al. Curr Opin Pediatr. .

Abstract

Purpose of review: Providers caring for children with end-stage kidney disease from rheumatologic conditions face questions such as when to proceed with kidney transplantation, how common is disease recurrence posttransplant, how does recurrent disease impact patient and allograft outcomes, and what approaches are available to prevent and treat recurrent disease. We discuss recent developments and relevant literature that address these questions for the most common rheumatologic disorders that lead to end-stage kidney disease in childhood namely, systemic lupus erythematosus, IgA nephropathy, IgA Vasculitis/Henoch Schoenlein Purpura, and Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis.

Recent findings: Recent data suggest that children with IgA nephropathy, IgA vasculitis, and ANCA-associated vasculitis have similar patient and allograft survival to other conditions despite the risk of recurrent disease, yet those with lupus have worse posttransplant patient and allograft outcomes. A period of disease quiescence may be prudent prior to transplantation to decrease the risk of recurrence, which is associated with decreased allograft survival. Data on preventive strategies and treatment options are limited.

Summary: It is recommended that patients with systemic rheumatologic conditions not be excluded from kidney transplantation but that patients be counseled on the risk of potential recurrent disease with its impact on transplant outcomes.

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References

    1. System USRD. 2020 USRDS Annual Data Report: epidemiology of kidney disease in the United States. 2020; Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases,
    1. Van Stralen KJ, Verrina E, Belingheri M, et al. Impact of graft loss among kidney diseases with a high risk of posttransplant recurrence in the paediatric population. Nephrol Dialysis Transplant 2018; 33:542.
    1. Briganti EM, Russ GR, McNeil JJ, et al. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 2002; 347:103–109.
    1. Aggarwal A, Srivastava P. Childhood onset systemic lupus erythematosus: how is it different from adult SLE? Int J Rheum Dis 2015; 18:182–191.
    1. Rovin BH, Adler SG, Barratt J, et al. Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney Int 2021; 100:753–779.

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