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Pediatric kidney transplant recipients differ from adult counterparts in primary disease, physiology, psychology, organ function and immune status and their perioperative treatment and nursing management are different from those of adult kidney transplantation. To standardize holistic perioperative nursing regimens for pediatric kidney transplantation, Surgery Nursing Committee of Shanghai Nursing Association organized national medical and nursing experts in the fields of transplantation to jointly draft "expert consensus on perioperative nursing standards for pediatric kidney transplantation " (abbreviated as "consensus"). After three rounds of online expert inquiry, all revised opinions were jointly discussed combined with literature evidence, and the expert consensus was finally reached. The highlights of perioperative treatment and nursing care for pediatric kidney transplantation were summarized and stated, including preoperative evaluation, preoperative and postoperative nursing care, which were of scientific and practical value.
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Objective To investigate the exposure difference of different dosage forms of mycophenolic acid (MPA) between children aged ≤12 and > 12 years old after kidney transplantation. Methods Clinical data of 73 children undergoing kidney transplantation from donation after cardiac death (DCD) were retrospectively analyzed. Postoperative immunosuppressive regimen was MPA+ tacrolimus+glucocorticoid. According to different dosage forms of MPA, all recipients were divided into group A (n=37, mycophenolate mofetil capsules), group B (n=28, enteric-coated mycophenolate sodium) and group C (n=8, mycophenolate mofetil dispersible tablets). All children were divided into ≤12 and > 12 years old groups according to the age of kidney transplantation. The daily dosage of different dosage forms was calculated. The blood concentration (C) of MPA and the area under the curve (AUC) were detected by enzyme-multiplied immunoassay technique. The MPA blood concentration was statistically compared between two age groups at different time points. The recovery of renal function and postoperative complications were assessed. Results No significant differences were observed in the dosage and blood concentration of drug at different time points among groups A, B and C (all P > 0.05). The MPA-C4 h and AUC in the ≤12 years old group were significantly higher than those in the > 12 years old group (both P < 0.05). In group B, the MPA-C4 h of children aged ≤12 years old was significantly higher compared with that in those aged > 12 years old (P=0.016). The MPA-C4 h of children aged ≤12 years old in group B was higher than those in group A and group C, but the differences were not statistically significant (P=0.080). There was no significant difference in the incidence of acute rejection and infection among three groups (both P > 0.05). Conclusions Children of different ages who are given with different dosage forms of MPA after kidney transplantation obtain different exposure rates. The exposure rate of kidney transplant recipients aged ≤12 years old tends to be higher than that of their counterparts aged > 12 years old, mainly seen in the recipients treated with enteric-coated mycophenolate sodium. Therefore, it is necessary to monitor the exposure level of MPA, which provides significant guidance for adjusting the drug dosage of different dosage forms.
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In recent years, clinical efficacy of pediatric kidney transplantation has been gradually enhanced with persistent progress of organ allocation policy, surgical technologies and perioperative management, etc. However, immunosuppressive management still plays a significant role in the long-term prognosis of pediatric kidney transplant recipients. Due to the disparity from adults in physiology, psychology, immune system and drug metabolism, immunosuppressive management in children should be delivered in a specific manner. Therefore, it is necessary to select appropriate immunosuppresants and formulate individualized immunosuppressive regimens according to the characteristics of pediatric kidney transplant recipients in clinical practice. In this article, the characteristics of immunosuppressive therapy, selection of immunosuppresants, glucocorticoid withdrawal, immune monitoring and medication compliance management of pediatric kidney transplant recipients were investigated, aiming to provide reference for optimizing immunosuppressive management and improving clinical prognosis of pediatric kidney transplant recipients.
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El trasplante renal de órganos provenientes de donantes adultos implantados en una cavidad anatómica estrecha en pacientes pediátricos de bajo peso, ofrece importantes desafíos médicos y quirúrgicos a ser considerados. En esta publicación reportamos el primer caso en el Paraguay de un riñón con dos arterias renales injertado a la aorta y vena cava inferior, dentro de la cavidad abdominal de un paciente pediátrico de 12 kilogramos de peso, evaluando las dificultades médicas, anatómicas y quirúrgicas enfrentadas, así como las opciones de tratamiento instituidas para llevar a cabo este procedimiento de manera exitosa
Kidney transplantation of organs from adult donors implanted into a narrow anatomical cavity in underweight pediatric patients offers significant medical and surgical challenges to be considered. In this publication we report the first case in Paraguay of a kidney with two renal arteries, grafted to the aorta and inferior vena cava within the abdominal cavity, on a 12 kilogram pediatric patient, evaluating the medical, anatomical and surgical conditions faced, as well as the treatment options instituted to successfully carry out this procedure
Subject(s)
Kidney Transplantation , Kidney , ArteriesABSTRACT
Objective To evaluate the current situation of quality of life and psychological status of pediatric recipients after kidney transplantation and analyze the influencing factors. Methods Ninety-six pediatric recipients undergoing kidney transplantation were enrolled in this study. Baseline data of the recipients were collected. The quality of life was assessed by Pediatric Quality of Life Inventory 3.0 (PedsQLTM3.0). The psychological status was evaluated by Strengths and Difficulties Questionnaire (SDQ). The influencing factors of postoperative quality of life and psychological status of pediatric kidney transplant recipients were subject to univariate and multivariate analyses. Results The total score of quality of life of pediatric kidney transplant recipients was (71±14) and (12.4±5.8) for the total difficulty score. Univariate analysis showed that gender, postoperative body mass index (BMI) and postoperative complications were the influencing factors of the total score of quality of life of pediatric kidney transplant recipients (all P < 0.05). Gender, postoperative complications and follow-up time were the influencing factors of the total difficulty score of pediatric kidney transplant recipients (all P < 0.05). Multivariate analysis demonstrated that gender, postoperative BMI, postoperative complications, dialysis type before kidney transplantation were the influencing factors of postoperative quality of life of pediatric kidney transplant recipients, whereas gender, postoperative complications and follow-up time were the influencing factors of postoperative psychological status (all P < 0.05). Conclusions The quality of life and psychological status of pediatric kidney transplant recipients are good. In clinical practice, special attention should be paid to those children who are female, with low BMI after kidney transplantation, postoperative complications and short follow-up time. Preventive interventions are recommended to further improve the quality of life of the children.
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Immunologic responses of infants and younger children differ from those of adults. Therefore, application of different pretransplant strategies for antibody depletion in younger ABO-incompatible transplant recipients is appropriate. A 12-month-old male infant with end stage renal disease after acute tubular necrosis was scheduled to undergo kidney transplantation from an ABO-incompatible living donor. He did not undergo pretransplant plasmapheresis, as the titer of the anti-ABO antibody was less than 1:4. After kidney transplantation, posttransplant renal function and anti-ABO titers were stable until posttransplant 2 years.
Subject(s)
Adult , Child , Humans , Infant , Male , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Living Donors , Necrosis , Plasmapheresis , TransplantationABSTRACT
OBJETIVO: Avaliar a influência da hipertensão arterial sistêmica com um ano de transplante renal na sobrevida do enxerto renal três anos após o transplante em crianças. MÉTODOS: Estudo observacional e retrospectivo na série de pacientes transplantados renais pediátricos da Universidade Federal de São Paulo (UNIFESP) no período de janeiro/1998 a janeiro/2003. Ao final do primeiro ano pós-transplante, os pacientes foram classificados em dois grupos: normotensos e hipertensos. A análise estatística de sobrevida foi através do método de Kaplan-Meier. A comparação entre grupos foi realizada utilizando-se o teste do "log-rank". Para os testes adotamos o limite de 5 por cento (α < 0,05) para rejeição da hipótese de nulidade. RESULTADOS: Antes do transplante 86 pacientes (64 por cento) e após um ano 70 indivíduos (52 por cento) foram classificados como hipertensos, respectivamente. A sobrevida do enxerto renal após três anos de transplante foi de 92,5 por cento para a amostra completa do estudo. O grupo de normotensos apresentou sobrevida de 95,3 por cento e os hipertensos 90 por cento; a diferença não foi estatisticamente significante. CONCLUSÃO: Apesar do resultado estatístico não ser significante, a diferença observada entre os dois grupos após três anos de transplante, de 5 por cento maior sobrevida nos indivíduos que eram normotensos um ano após o transplante, nos parece clinicamente significativa e nos permite levantar a hipótese de que a hipertensão arterial pode ser um fator de risco para a sobrevida do enxerto pediátrico. Entretanto, não nos seria possível afirmar que a hipertensão é fator de risco independente para menor sobrevida do enxerto devido às limitações do estudo.
BACKGROUND: To evaluate the effect of 1 year systemic arterial hypertension on 3-year allograft survival in children with kidney transplantation. METHODS: A retrospective study was carried out of pediatric patients submitted to kidney transplantation at the Universidade Federal de São Paulo (UNIFESP) between January, 1998 and January, 2003. Patients were classified as normotensive or hypertensive according to presence of hypertension within the first year after transplantation. Survival analyses were performed with the Kaplan-Meier survival method, and survival curves were compared with the log-rank test. A p value of < 0.05 was considered statistically significant. RESULTS: Prior to transplantation there were 86 patients (64 percent) and after 1 year, 70 children (52 percent) were classified as hypertensive, respectively. Overall, the 3-year graft survival was of 92.5 percent. Survival of the normotensive group was 95.3 percent and 90.0 percent for the hypertensive group; the difference was not statistically significant. CONCLUSION: Although the difference between the two groups was not statistically significant the higher survival of the normotensive group seems to be clinically significant and allows hypothesizing that arterial hypertension could be a risk factor for pediatric graft survival. However, due to limitations of the study it is impossible to affirm that hypertension is an independent risk factor for lower graft survival.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Graft Survival , Hypertension/complications , Kidney Transplantation , Brazil/epidemiology , Epidemiologic Methods , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/etiology , Risk Factors , Time Factors , Transplantation, HomologousABSTRACT
According to the donor shortage, the marginal donor should be concerned as one of the potential kidney sources. The pediatric kidney could be transplanted to adult recipient, but it is well known that small functioning nephron mass could cause the late graft dysfunction according to the hyperfiltration syndrome. Here, we report a case of successful kidney transplantation in adult using en bloc kidneys from a child with good long term graft function.