ESPN 50th Annual Meeting

ESPN 2017


 
THE CHANGING LANDSCAPE OF PAEDIATRIC KIDNEY TRANSPLANTATION OVER TWO DECADES
CHRISTINE WILLIAMS 1 JENNIFER MCCAUGHAN 2 AISLING COURTNEY 2 MAIREAD CONVERY 1

1- ROYAL BELFAST HOSPITAL FOR SICK CHILDREN
2- BELFAST CITY HOSPITAL
 
Introduction:

Kidney transplantation is a life transforming procedure for children and their families. However, graft and recipient outcomes can be compromised by early technical difficulties, non-concordance with medication and the side effects of immunosuppression. Knowledge of the clinical course of children who have received kidney transplants is essential to guide practice.

Material and methods:

Our objectives were to review the demographics of paediatric kidney transplants performed in Northern Ireland over the past 20 years. In addition, we wanted to evaluate the long term graft and recipient outcomes after paediatric kidney transplantation. All recipients of paediatric kidney transplants performed in Northern Ireland from 1995-2016 were included. Donor and recipient demographics and transplant details are recorded at the time of transplantation. Recipient and donor outcomes were collected prospectively. Recipients were followed up until death or 1st December 2016.

Results:

There were 78 transplants performed during the study period; 61% of recipients were male. The median age was 12 years. The median duration of pre-transplant renal replacement therapy was 14 months. Eighteen patients were transplanted pre-emptively; 50% of transplants performed since 2010 have been pre-emptive.The median donor age was 29 years and kidneys were donated after brain death in 65% of cases. Since 2010, donor demographics have shifted in favour of living donation and the majority of transplants performed in the past five years have been from living donors. The median number of HLA mismatches was two and the ischaemic time ranged from 143-2785 minutes (median 1143 minutes). The median follow up time was 9.6 years. 71 patients were discharged with a functioning graft. Discharge creatinine was available for 66 patients with a range of 22-197 μmol/L and a median of 60 μmol/L. One and two years after transplant, the median creatinine was 76 μmol/L and 87 μmol/L respectively.The median graft survival was 84.5 months. There were 22 cases of death-censored graft loss in the study period. In five, graft loss was secondary to early technical problems; these all occurred between 1995 and 2005. In the other 17, grafts functioned for 5 – 18 years prior to failure. In multivariate analysis, recipient age, donor age and era of transplantation were associated with graft survival.

Three deaths occurred in the follow up period. Two patients died within the first month and a third died from post-transplant lymphoproliferative disorder 17 years after transplantation.

Conclusions:

There have been many improved developments over the past twenty years after paediatric kidney transplantation in Northern Ireland. There have been no early graft losses or deaths in the past decade. The expansion of the living donor programme means that 50% of children are now transplanted pre-emptively, removing the detrimental effect of dialysis therapy on their health and development. The overall outcomes are now excellent and boast an impressive foundation for future transplant outcomes.