Pediatric kidney transplantation - 35 years experience at a reference center

Abstract

Introduction: To analyze the experience at Oporto University Hospital Center (CHUP) in pediatric kidney transplantation. Methods: Retrospective single center observational study, including pediatric kidney transplant patients between January 1984 and November 2019 at CHUP Renal Transplantation Unit. Results: In this period, 165 kidney transplants were performed, in a total of 157 patients under 18 years old. One hundred and fifty-one grafts came from cadaveric donor versus 14 from living donors. It was carried out 21 preemptive transplants, with most patients previously undergoing dialysis (50% only peritoneal dialysis). The median dialysis waiting time for transplantation was 10 months. Ninety-two (59%) were male patients with 13 years (3 - 18) median age at intervention. The main etiology of kidney disease was congenital anomalies of the kidney and urinary tract (CAKUT), reported in 58%. Donors had a median age of 17 years (1 - 58) and terminal serum creatinine 1.00 mg/dL (0.30 – 2.10). The hospital stay was 14 days (4 - 60). There were 24 episodes of tubular necrosis after transplantation, and 35 episodes of acute rejection. Renal graft and patient survival were 94%, 87%, 77% and 62% and 99%, 98%, 98% and 93% at 1, 5, 10 and 20 years, respectively. Subgroups of analysis of decades has documented increasing survival rates (p-value <0.001). Conclusion: The results corroborate the literature and state an excellent survival associated to pediatric kidney transplantation. Although larger impact multicenter studies are needed, this analysis holistically represents the national reality of this modality.