|Year : 2019 | Volume
| Issue : 2 | Page : 99-100
Pediatric renal transplants
RB Nerli1, Shridhar C Ghagane2
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 Publication||4-Jun-2019|
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
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nerli R B, Ghagane SC. Pediatric renal transplants. Indian J Health Sci Biomed Res 2019;12:99-100
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.,, 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.,
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., The technique followed in PRT is different and must be individualized with patient-specific anatomical considerations., Surgeon's experience and skill greatly affect graft survival and related surgical morbidity., 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., 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.
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