Abstract:

Objective

To summarize the clinical characteristics and efficacy of kidney transplantation in children with end-stage renal disease (ESRD).

Methods

The clinical features and follow-up results of children with ESRD after kidney transplantation in Children's Hospital of Chongqing Medical University were analyzed retrospectively. The primary diseases, clinical manifestations,dialysis state, donor features, operation and follow-up results were summarized and analyzed. The dynamic changes of renal allograft function within 2 weeks after operation and prognosis were observed.

Results

A total of 31 pediatric kidney transplantat recipients were included, 15 males and 16 females,with a median age of 13.5 years. The clinical presentation was atypical, and 67.7% (21/31) of the children were emaciated. The primary disease was primary urological abnormalities in 41.9% (13/31)and nonurological abnormalities in 58.1% (18/31). The median waiting time from the diagnosis of ESRD to renal transplantation was 10 months, and only 12.9% obtained preemptive renal transplantation. The median warm ischemia time of donor kidney was 6 min, the median cold ischemia time was 5 h, and the median operation time of renal transplantation was 162.5 min. Stable dialysis creatinine levels were achieved in 25.0%, 59.3%, 86.2%, and 92.0% of children at 1, 2, 3, and 4 days after surgery, respectively, and renal allograft function recovered close to normal in most children within 1 week. As of August 2024, the median postoperative follow-up time was 8 months. During follow-up, there were 2 cases of renal allograft failure, 2 cases of antibody-mediated acute rejection,and 2 cases of BK virus infection.

Conclusions

The clinical manifestations of children with ESRD are atypical and non-specific. The overall effect of pediatric kidney transplantation is promising, and most recipients gradually tend to have stable renal allograft function 4 days after surgery.

Key words: Pediatric kidney transplantation, End-stage renal disease, Clinical characteristics, Therapeutic efficacy, Graft renal function