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      Long-term outcome after renal transplantation in childhood

      other
      Author(s): 1 , 2 ,
      Publication date (Electronic):
      Journal: Pediatric Nephrology (Berlin, Germany)
      Publisher: Springer-Verlag
      Keywords: Long-term outcome, Mortality, Graft survival, Growth, Psycho-social

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract and learning objectives:

          The purpose of this article is to review:

          1. Factors influencing long-term outcome data after transplantation

          2. Patient survival overall, the effect of recipient age and donor type, causes of death, comparison of mortality after transplantation with that on dialysis, and effect of pre-emptive transplantation and race

          3. Transplant survival overall, and the effect of recipient and donor age, donor type, pre-emptive transplantation, recurrent diseases, human leukocyte antigen (HLA) matching, immunosuppression, concordance, hypertension, bladder dynamics and type of donor nephrectomy

          4. Final height and obesity

          5. Psycho-social outcome

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          Most cited references79

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          Cardiovascular mortality in children and young adults with end-stage kidney disease.

          Daniel C. Carroll, Robert Port, R Wolfe … (2002)
          To analyze cardiovascular death in a national end-stage renal disease (ESRD) population. This retrospective, observational study with data from the US Renal Data Systems analyzed 1380 deaths from 1990 to 1996 among patients who started ESRD therapy as children and died before 30 years of age. Percentage of cardiac deaths (n = 311) varied by age and was higher among black patients (0-4 years, 36%; 5-9 years, 18%; 10-14 years, 35%; 15-19 years, 22%; 20-30 years, 32%) than white patients (18%, 12%, 17%, 14%, and 23%, respectively). Among black patients, cardiac deaths occurred in 11% of transplant recipients, 34% of dialysis patients, and among white patients 9% and 25%, respectively. Black patients were 1.6 times more likely to die of a cardiac death (P <.001) than white patients. Transplant recipients had 78% lower risk of cardiac death than dialysis patients (odds ratio = 0.22; P =.0001). The cardiac death rate among dialysis patients was 21.4 per 1000 patient-years in black patients compared with 20.5 in white patients. Transplantation cardiac death rates were lower in black patients, 2.1 per 1000 patient-years, and 1.3 in white patients. Cardiovascular death accounts for 23% of pediatric and young adult ESRD deaths. Black patients and dialysis patients are at higher risk of a cardiac death compared with white patients and transplant recipients. Further studies are needed to identify risk factors associated with cardiovascular death in patients with ESRD.
          Article 0 comments Cited 65 times – based on 0 reviews     Review now
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            Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study.

            Jaap W Groothoff, Eric Wolff, Jean-Claude Davin … (2002)
            To establish mortality rates, causes of death, and determinants of mortality in children with end-stage renal disease (ESRD), we performed a national long-term follow up study. Mortality rate was determined in all Dutch patients with onset of ESRD at ages 0 to 14 years in the period between 1972 and 1992. Causes of death and mortality determinants were investigated in all patients of this cohort who were born before 1979. Data were derived from the Dutch Registry for patients on renal replacement therapy (RRT), medical charts and National Health Database. Of all 381 patients 85 had died. The overall mortality rate (MR) was 1.57/100 patient-years, and the standardized mortality rate (SMR) was 31.0. The MR for patients 0 to 5 and 6 to 10 years old at onset of ESRD decreased from, respectively, 7.0 (range 0-14.9) to 3.9 (1.2-6.7) and 4.3 (1.1-7.5) to 1.6 (0.3-2.8) between the periods 1972-1981 and 1982-1992. The mortality hazard ratio of relatively long standing dialysis and of long standing hypertension were, respectively, 7.2 (4.4-11.8) and 3.1 (2.1-4.6), of cyclosporine-introduction in transplanted patients 0.3 (0.1-0.4). Overall cerebrovascular accidents (24%) and infections (21%) were the most common causes of death; after 10 years of RRT cardiac death (7/21) was most prevalent. Cardiovascular death was most prominent in dialysis as well as transplanted patients. Survival in children with ESRD has increased over the last 20 years, but the SMR remains high. Early transplantation and a more vigorous approach toward hypertension and infection may be mandatory in order to further reduce mortality.
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              Effect of growth hormone treatment on the adult height of children with chronic renal failure. German Study Group for Growth Hormone Treatment in Chronic Renal Failure.

              E Wühl, O Mehls, Juergen Schaefer … (2000)
              Growth hormone treatment stimulates growth in short children with chronic renal failure. However, the extent to which this therapy increases final adult height is not known. We followed 38 initially prepubertal children with chronic renal failure treated with growth hormone for a mean of 5.3 years until they reached their final adult height. The mean (+/-SD) age at the start of treatment was 10.4+/-2.2 years, the mean bone age was 7.1+/-2.3 years, and the mean height was 3.1+/-1.2 SD below normal. Fifty matched children with chronic renal failure who were not treated with growth hormone served as controls. The children treated with growth hormone had sustained catch-up growth, whereas the control children had progressive growth failure. The mean final height of the growth hormone-treated children was 165 cm for boys and 156 cm for girls. The mean final adult height of the growth hormone-treated children was 1.6+/-1.2 SD below normal, which was 1.4 SD above their standardized height at base line (P< 0.001). In contrast, the final height of the untreated children (2.1+/-1.2 SD below normal) was 0.6 SD below their standardized height at base line (P<0.001). Although prepubertal bone maturation was accelerated in growth hormone-treated children, treatment was not associated with a shortening of the pubertal growth spurt. The total height gain was positively associated with the initial target-height deficit and the duration of growth hormone therapy and was negatively associated with the percentage of the observation period spent receiving dialysis treatment. Long-term growth hormone treatment of children with chronic renal failure induces persistent catch-up growth, and the majority of patients achieve normal adult height.
              Article 0 comments Cited 44 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : +44-207-8138346 , +44-207-8298841 , L.Rees@ich.ucl.ac.uk
                Journal
                Journal ID (nlm-ta): Pediatr Nephrol
                Title: Pediatric Nephrology (Berlin, Germany)
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0931-041X
                ISSN (Electronic): 1432-198X
                Publication date (Electronic): 9 August 2007
                Publication date (Print): March 2009
                Volume: 24
                Issue: 3
                Pages: 475-484
                Affiliations
                [1 ]Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
                [2 ]Department of Nephrourology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK
                Article
                Publisher ID: 559
                DOI: 10.1007/s00467-007-0559-2
                PMC ID: 2755795
                PubMed ID: 17687572
                SO-VID: e4c01fd3-0032-4542-9083-0ac378f0a690
                Copyright © © IPNA 2007
                History
                Date received : 11 May 2007
                Date revision received : 19 June 2007
                Date accepted : 19 June 2007
                Categories
                Subject: Educational Feature
                Custom metadata
                issue-copyright-statement © IPNA 2009

                ScienceOpen disciplines: Nephrology
                Keywords: mortality,growth,graft survival,long-term outcome,psycho-social
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: mortality, growth, graft survival, long-term outcome, psycho-social

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