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. 2022 Apr 8:10:856630.
doi: 10.3389/fped.2022.856630. eCollection 2022.

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

Loes Oomen  1 , Charlotte Bootsma-Robroeks  2   3 , Elisabeth Cornelissen  2 , Liesbeth de Wall  1 , Wout Feitz  1
Affiliations

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

Loes Oomen et al. Front Pediatr. .

Abstract

Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.

Keywords: donor selection; graft survival; immunosuppression; lower urinary tract dysfunction; pediatric kidney transplantation; pediatric nephrology; pediatric urology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Graft survival per decade of transplantation. T0, moment of transplantation. DD, deceased donor; LD, Living Donor.
Figure 2
Figure 2
Mode of pre-transplantation treatment per era of transplantation. PKT, pre-emptive kidney transplantation; HD, hemodialysis; PD. peritoneal dialysis.
Figure 3
Figure 3
Percentage of living donors and IQR donor age stratified for different time periods. LD, living donor.
Figure 4
Figure 4
Overview of different ureteroneocystostomy methods.
Figure 5
Figure 5
Immunosuppressive maintenance regimen at 3 months after transplantation. MMF, mycophenolate mofetil.
See this image and copyright information in PMC

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