Growth following solid organ transplantation in childhood

One of the ultimate goals of successful solid organ transplantation in pediatric recipients is attaining an optimal final adult height. This manuscript will discuss growth following transplantation in pediatric recipients of kidney, liver, heart, lung or small bowel transplants. Remarkably similar factors impact growth in all of these recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributing factor, with a reduced glomerular filtration rate correlating with poor growth in kidney recipients and the need for re-transplantation with impaired growth in liver recipients. The known adverse impact of steroids on growth has led to modification of the steroid dose and even steroid withdrawal and avoidance. In kidney and liver recipients, this strategy has been associated with the development of acute rejection. In infant heart transplantation, avoiding maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of patients. With marked improvements in patient and graft survival rates in pediatric organ recipients, quality of life issues, such as normal adult height, should now receive paramount attention. In general, normal growth following solid organ transplantation should be an achievable goal that results in normal adult height.

Common challenge topics in pediatric transplantation

This special issue is dedicated to the common challenge topics in pediatric transplantation. It contains 11 chapters, ranging from clinical research in pediatric transplantation to translational research (from bench to bedside). It includes comprehensive reviews from renowned scientists, clinicians and surgeons from five countries from the International Pediatric Transplantation Association (IPTA), Harvard University, the University of Miami and the University of São Paulo Medical School. The clinical management of specific issues, such as sensitized patients and ABO blood type-incompatible transplantation, is addressed. In addition, the challenges facing this patient population and the future perspectives for clinical research are discussed.

Fours years experience: CAPD and CCPD in children

Desde agosto de 1980 hasta agosto de 1984 fueron entrenados 80 pacientes para diálisis peritoneal domiciliaria en la División Nefrología Pediátrica (UCLA), 66 (81%) fueron primariamente entrenados para DPCA y 14 (19%) para DPCC. Finalmente 24 pacientes entrenados para DPCA fueron traslados a DPCC, 1 paciente fue traslado de DPCC a DPCA y 5 pacientes tuvieron que ser derivados a hemodiálisis por falla de la membrana peritoneal subsiguiente a una peritonitis. En setiembre d 1985 un total de 43 pacientes se encontraban en tratamiento con diálisis peritoneal domiciliaira: 18 en DPCA y 25 en DPCC. La experiencia total con DP domiciliaria fue de 1.274 pacientes-mes, en DPCA de 850 pacientes-meses y en DPCC de 424 pacientes-mes. Veintinueve pacientes recibieron 32 trasplante renales (21 de donante cadavérico y 11 de donante vivo relacionado). En setiembre de 1985, 22 pacientes tenían un injerto funcionando. Dos pacientes fallecieron, uno por causa de miocardiopatía y el otro por una severa hemorragia gastrointestinal y retroperitoneal en el período inmediato postrasplante. En total se registraron 113 episodios de peritonitis en un período de 1.274 pacientes-mes, es decir hubo un epidosio cada 11,3 pacientes-mes. En DPCA el promedio fue de 1 cada 11,8 pacientes-mes y en DPCC fue de 1 cada 10,3 pacientes-mes. De los 113 episodios de peritonitis, 44 cultivos no mostraron crecimiento bacteriano, 37 revelaron gérmenes Gram positivos y 26 bacterias Gram negativas, uno desarrollo anaerobios, mientras que en tres episodios se demostraron dos organismos. La incidencia de peritonitis micótica fue de sólo dos casos...