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Cover page of the Journal of Health Sciences


 
 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 99-100

Pediatric renal transplants


1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus; Department Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and M.R.C., Belagavi, Karnataka, India
2 Department Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and M.R.C., Belagavi, Karnataka, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. R B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_99_19

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How to cite this article:
Nerli R B, Ghagane SC. Pediatric renal transplants. Indian J Health Sci Biomed Res 2019;12:99-100

How to cite this URL:
Nerli R B, Ghagane SC. Pediatric renal transplants. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Jun 20];12:99-100. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/99/259647



It is well known from several studies that children with end-stage renal disease (ESRD) benefit from early renal transplantation regarding mental and physical quality of life.[1],[2],[3] Patient survival rates following pediatric renal transplant have improved due to advancements in surgical technique, immunosuppression, rates of living donor transplantation, and organ allocation policies. Renal transplant has become the preferred treatment modality and a safe contemporary option for the management of pediatric ESRD.[2],[4]

Pediatric renal transplantation (PRT) differs from adult renal transplantation as ESRD in children is often secondary to congenital anomalies of the kidney and urinary tract.[5],[6] The technique followed in PRT is different and must be individualized with patient-specific anatomical considerations.[7],[8] Surgeon's experience and skill greatly affect graft survival and related surgical morbidity.[9],[10] Surgeons performing adult renal transplantation have no distinguishable learning curve for complications, while the duration of operation could be decreased through experience. PRT in most centers in North America and Europe is performed by a dedicated transplant team, unlike in India wherein these procedures are performed by urological services. Chua et al. assessed the achievement of competence in pediatric renal transplant by developing a learning curve model.[11],[12] They retrospectively evaluated pediatric renal transplant cases performed by an index pediatric urologist and compared to those of a reference senior surgeon. Total operative time was shorter (226 vs. 252 min, P = 0.006), while ischemia time was longer (40 vs. 30 min, P = 0.001) for the index surgeon compared to the reference senior surgeon. The 30-day surgical complication rates were similar (32.7% and 35.9%, P = 0.853).

Preparation and management of a child for renal transplant, particularly with an underlying urologic condition, require a thorough understanding of the patterns of bladder dysfunction and clear strategies for the evaluation and treatment before transplant. One should rightly anticipate the needs and constraints of the transplant procedure. Posttransplant monitoring is necessary so as to expect and identify pathologic processes before they have damaged renal graft function irreversibly. A high index of suspicion and a clear sense of the patient's risk help in good outcome in these processes. A multidisciplinary collaboration among the pediatric nephrology, urology, and transplant surgical teams is critical to maximizing patient and graft survival.



 
  References Top

1.
Dixit N, Nerli R, Ghagane S, Hiremath M, Guntaka A. The role of public relation in-charge in kidney transplantation: The cognitions, emotions, ethical, and religious issues in a multicultural society like India. Int J Nephrol Kidney Failure 2015;2:1-7.  Back to cited text no. 1
    
2.
Nerli RB, Ghagane SC, Patil MV, Dixit NS. Renal transplant in a child with Alport syndrome. Indian J Transplant 2017;11:86.  Back to cited text no. 2
  [Full text]  
3.
Chavers BM, Rheault MN, Matas AJ, Jackson SC, Cook ME, Nevins TE, et al. Improved outcomes of kidney transplantation in infants (Age < 2 years): A single-center experience. Transplantation 2018;102:284-90.  Back to cited text no. 3
    
4.
Groothoff JW, Offringa M, Grootenhuis M, Jager KJ. Long-term consequences of renal insufficiency in children: Lessons learned from the Dutch LERIC study. Nephrol Dial Transplant 2018;33:552-60.  Back to cited text no. 4
    
5.
Cho MH. Pediatric kidney transplantation is different from adult kidney transplantation. Korean J Pediatr 2018;61:205-9.  Back to cited text no. 5
    
6.
Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol 2012;27:363-73.  Back to cited text no. 6
    
7.
Hussein AA, Shoukry AI, Fadel F, Morsi HA, Hussein HA, Sheba M, et al. Outcome of pediatric renal transplantation in urological versus non-urological causes of end stage renal disease: Does it matter? J Pediatr Urol 2018;14:e1-166.e7.  Back to cited text no. 7
    
8.
Dharnidharka VR, Fiorina P, Harmon WE. Kidney transplantation in children. N Engl J Med 2014;371:549-58.  Back to cited text no. 8
    
9.
Vitola SP, Gnatta D, Garcia VD, Garcia CD, Bittencourt VB, Keitel E, et al. Kidney transplantation in children weighing less than 15 kg: Extraperitoneal surgical access-experience with 62 cases. Pediatr Transplant 2013;17:445-53.  Back to cited text no. 9
    
10.
Lin HM, Kauffman HM, McBride MA, Davies DB, Rosendale JD, Smith CM, et al. Center-specific graft and patient survival rates: 1997 United Network for Organ Sharing (UNOS) Report. JAMA 1998;280:1153-60.  Back to cited text no. 10
    
11.
Studer P, Inderbitzin D. Surgery-related risk factors. Curr Opin Crit Care 2009;15:328-32.  Back to cited text no. 11
    
12.
Chua ME, Ming JM, Kim JK, Degheili J, Santos JD, Farhat WA. Competence in and learning curve for pediatric renal transplant using cumulative sum analyses. J Urol 2019;201:1199-205.  Back to cited text no. 12
    




 

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