ESPN 50th Annual Meeting

ESPN 2017


 
10 year experience of paediatric renal transplantation - a review of 420 cases
PANKAJ CHANDAK 1 JELENA STOJANOVIC 2 FAISAL JAMSHAID 1 NIZAM MAMODE 1 FRANCIS CALDER 1 JONATHON OLSBURGH 1 CHRIS CALLAGHAN 1 MARTIN DRAGE 1 GEOFF KOFFMAN 1 STEPHEN D MARKS 3 NICOS KESSARIS 1

1- GUYS AND ST THOMAS AND EVELINA CHILDRENS AND GREAT ORMOND STREET HOSPITALS
2- EVELINA CHILDRENS HOSPITAL
3- GREAT ORMOND STREET HOSPITAL
 
Introduction:

Renal transplantation is the gold standard treatment for end-stage kidney disease. There are increased challenges in performing transplantation for prospective paediatric renal transplant recipients (pRTR) under 20kg, especially when placing an adult kidney into a small abdomen.

Material and methods:

Data was retrieved from a prospectively collected database, electronic records and hospital notes from two paediatric transplant units in UK. eGFR was calculated using the Schwartz formula. Death-censored renal allograft survival and patient survival were assessed using Kaplan-Meier analysis.

Results:

420 children, (between 2005 and 2015), were divided according to weight: Group A (<20kg): 116 (28%) and Group B (>20kg): 303 (72%) pRTR. Median age for Group A was 3 (IQR 2-4) and Group B, 13 (IQR 10-15) years (p < 0.001). Patient survival was 98% and 99.7% and renal allograft survival was 93% and 90% in Group A and B respectively, at median follow up of 2 (IQR 1-5) years. Three (38%) and four (48%) renal allograft losses in Group A and B, respectively were due to rejection. 1/116 in Group A and 29/303 in Group B were re-transplants. The last median eGFR was 61 (IQR 48-74) and 51 (IQR 40-63) mls/min/1.73m2 in Group A and B respectively (p < 0.001). There was no significance difference between the groups with respect to patient and renal allograft survival (p = 0.13 and 0.28 respectively).

Conclusions:

Despite the obvious difference in age between the two groups, the overall patient and graft survival was similar between children <20kgs and >20kgs in this cohort. Transplantation in small children is feasible with good outcomes.