Consideraciones en el inicio y seguimiento del paciente pediátrico con trasplante renal / Considerations of the initiation and follow-up of the pediatric patient with renal transplant

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Seguridad a largo plazo en el donante vivo para trasplante renal pediátrico. Estudio prospectivo, unicéntrico / Long-term safety in living kidney donors for paediatric transplantation. Single-centre prospective study

Introducción: Existe evidencia suficiente sobre la seguridad a corto plazo en el donante vivo tras el trasplante renal. Sin embargo, las complicaciones a largo plazo continúan siendo un área de estudio en la actualidad, de especial interés en el donante joven. Previamente se han realizado análisis en donantes de edad más avanzada para enfermos renales adultos. Presentamos un estudio de complicaciones a largo plazo en donantes renales para nuestra población pediátrica. Métodos: Estudiamos a largo plazo a los donantes de los 54 trasplantes renales de donante vivo realizados en nuestro servicio desde 1979 hasta junio del 2014. Hemos monitorizado el filtrado glomerular (FG) mediante aclaramiento de creatinina en orina de 24 h, proteinuria en orina de 24 h y el desarrollo de hipertensión arterial (HTA) en los 48 donantes que han presentado un seguimiento mayor de un año. En el análisis de resultados se han incluido tan solo a los 39 pacientes que han sido exclusivamente controlados en nuestro servicio. Resultados: El FG mediante aclaramiento de creatinina fue estable tras su descenso inicial. No se observó proteinuria en ninguno de los casos. Se observó enfermedad renal crónica (ERC) avanzada en un paciente, lo cual supuso una incidencia acumulada del 2%, no describiéndose FG menor de 60mL/min/1,73m2 en ningún otro paciente. La HTA fue diagnosticada en el 25% de los donantes, con tratamiento hipotensor en el 90% de ellos. Conclusiones: El riesgo de ERC y de HTA en donantes renales vivos para receptor pediátrico cuidadosamente monitorizados en su evolución es similar al de la población general por lo que parece tratarse de una técnica segura a corto y largo plazo (AU)

Introduction: There is enough evidence concerning the short-term safety of living donors after kidney transplantation. However, long-term complications continue to be studied, with a particular interest in young donors. Previous studies have been conducted in older donors for adult renal patients. We present a study of long-term complications in kidney donors for our paediatric population. Methods: We carried out a long-term donor study for the 54 living kidney-donor transplantations performed at our department from 1979 to June 2014. We monitored the glomerular filtration rate (GFR) on the basis of 24-hour urine creatinine clearance, 24-hour proteinuria and the development of arterial hypertension in the 48 donors who were followed up for more than one year. Only the 39 patients who were exclusively followed up by our department have been included in the results analysis. Results: GFR through creatinine clearance was stable after an initial decrease. No proteinuria was observed in any of the cases. One patient developed chronic kidney disease (CKD), which resulted in a cumulative incidence of 2%. GFR below 60mL/min/1.73 m2 was not reported in any other patients. Arterial hypertension was diagnosed in 25% of donors, 90% of which were treated with antihypertensives. Conclusions: Risk of CKD and hypertension in living kidney donors for paediatric recipients, who are carefully monitored throughout their evolution, is similar to that of the general population. Therefore, this technique appears to be safe in both the short and long term (AU)

Long-term safety in living kidney donors for paediatric transplantation. Single-centre prospective study. / Seguridad a largo plazo en el donante vivo para trasplante renal pediátrico. Estudio prospectivo, unicéntrico.

INTRODUCTION: There is enough evidence concerning the short-term safety of living donors after kidney transplantation. However, long-term complications continue to be studied, with a particular interest in young donors. Previous studies have been conducted in older donors for adult renal patients. We present a study of long-term complications in kidney donors for our paediatric population. METHODS: We carried out a long-term donor study for the 54 living kidney-donor transplantations performed at our department from 1979 to June 2014. We monitored the glomerular filtration rate (GFR) on the basis of 24-hour urine creatinine clearance, 24-hour proteinuria and the development of arterial hypertension in the 48 donors who were followed up for more than one year. Only the 39 patients who were exclusively followed up by our department have been included in the results analysis. RESULTS: GFR through creatinine clearance was stable after an initial decrease. No proteinuria was observed in any of the cases. One patient developed chronic kidney disease (CKD), which resulted in a cumulative incidence of 2%. GFR below 60mL/min/1.73 m2 was not reported in any other patients. Arterial hypertension was diagnosed in 25% of donors, 90% of which were treated with antihypertensives. CONCLUSIONS: Risk of CKD and hypertension in living kidney donors for paediatric recipients, who are carefully monitored throughout their evolution, is similar to that of the general population. Therefore, this technique appears to be safe in both the short and long term.

[Ten years of renal transplantation in children]. / Diez años de trasplante renal en niños.

One hundred and fourteen kidney transplants (87 first and 27 second and thirds) were performed in 90 children aged 1 to 15 years during the period 1979-1988; 44% were under 10 years, 14% under 5 and 8% under 3 years of age. The renal grafts were from living related donor (LD) in 30 cases and from cadaveric donor (CD) in 84; 91 were from adult donors and 23 from pediatric ones. The actuarial survival rate of the patients at one and two years was 100% in the LD and 92 and 90% respectively in the CD group. The actuarial survival rate of the first graft at one two years was 98% and 78% in the LD and 83% and 68% in the CD group. When gathered for the receptor age the actuarial survival rate of the first graft was 78 and 67% in the 1-5 years group (n = 19) and 86 and 71% in the 6-15 years one (n = 68). Serum creatinine level was 0.9 +/- 0.4 mg/dl three months, 1.2 +/- 0.7 mg/dl at one year, an 1.8 +/- 1.2 mg/dl at two years among the 50 transplants with a follow-up over two years.