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1.
Pediatr Nephrol ; 30(8): 1343-8, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25750075

ABSTRACT

BACKGROUND: Left ventricular (LV) systolic dysfunction is a relatively uncommon but serious complication of pediatric chronic kidney disease, and may be related to uremia and uncontrolled hypertension. There is limited information on the strategy for managing these children. In some cases, combined heart-kidney transplant may be considered or kidney transplant delayed until cardiac function improves. It is unknown whether these patients are at increased risk for poor outcomes after kidney transplantation. METHODS: We conducted a retrospective, multicenter study on the outcomes of children with severe and symptomatic cardiomyopathy who underwent kidney transplantation. RESULTS: Eleven patients receiving maintenance dialysis with systolic dysfunction underwent kidney transplantation without simultaneous heart transplant. Nine patients had congestive heart failure in the pre-transplant period. There were no identified complications post-transplant related to the underlying cardiac dysfunction. LV systolic function normalized in all patients and the mean shortening fraction increased from 19.0 ± 4.6 % to 32.0 ± 4.4 % (p < 0.0001). CONCLUSIONS: Kidney transplantation should be considered for children receiving maintenance dialysis with severe LV dysfunction.


Subject(s)
Kidney Transplantation/methods , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/surgery , Ventricular Dysfunction, Left/complications , Adolescent , Child , Child, Preschool , Female , Graft Survival , Humans , Male , Retrospective Studies
2.
Transplantation ; 96(6): 550-4, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23912170

ABSTRACT

BACKGROUND: Focal segmental glomerulosclerosis (FSGS), the second leading cause of end stage renal disease in children, appears to be increasing. Moreover, posttransplantation FSGS recurrence is a major problem, and there is concern that children receiving kidneys from living donors (LD) have increased recurrence risk. METHODS: Data from the United Network for Organ Sharing from 1988 to 2008 were analyzed for number of de novo transplant recipients with a primary diagnosis of FSGS in children 1 to 20 years of age. Poisson regression was used for trend analysis. Univariate and multivariable logistic regression analyses were performed to examine the association of gender, race, human leukocyte antigen matching, age, and donor type with recurrence. RESULTS: Trend analysis of kidney transplantations for FSGS in children (n=2157) showed an increase in cases of 5.8% per year or 209% over 20 years (P<0.0001). Recurrence was reported in 327 (15%) cases overall, with a preponderance for white recipients (P<0.001) in younger age subgroups (P<0.01). Donor type was significant (P=0.02), with recurrence reported in 17% versus 14% of recipients of kidneys from LDs versus deceased donors. Using multivariate analysis, recipients' young age (P=0.02) and white race (P<0.001) were identified as significant risk factors for recurrence, whereas receiving a LD kidney became insignificant. CONCLUSIONS: FSGS as a cause of pediatric end-stage renal disease leading to transplantation is on the rise. FSGS recurrence is highest in young, white children, whereas receiving a LD kidney is not independently associated with increased risk of recurrence.


Subject(s)
Glomerulosclerosis, Focal Segmental/surgery , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Tissue Donors/supply & distribution , Adolescent , Age Factors , Chi-Square Distribution , Child , Child, Preschool , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/ethnology , HLA Antigens/immunology , Histocompatibility , Humans , Infant , Kidney Failure, Chronic/ethnology , Kidney Failure, Chronic/etiology , Kidney Transplantation/immunology , Kidney Transplantation/trends , Living Donors , Logistic Models , Multivariate Analysis , Odds Ratio , Recurrence , Risk Factors , Sex Factors , Time Factors , Tissue and Organ Procurement , Treatment Outcome , United States , White People , Young Adult
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