Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2022 Apr 25

PMID 35463874

Authors

Loes Oomen

Charlotte Bootsma-Robroeks

Elisabeth Cornelissen

Liesbeth de Wall

Wout Feitz

Affiliations

Soon will be listed here.

Abstract

Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.

Citing Articles

International validation of a pre-transplant risk assessment tool for graft survival in pediatric kidney transplant recipients.

Oomen L, de Wall L, Tonshoff B, Krupka K, Harambat J, Hogan J Clin Kidney J. 2025; 18(3):sfaf031.

PMID: 40052169 PMC: 11883223. DOI: 10.1093/ckj/sfaf031.

Identifying Risk Factors for Graft Failure due to Chronic Rejection < 15 Years Post-Transplant in Pediatric Kidney Transplants Using Random Forest Machine-Learning Techniques.

Suh H Pediatr Transplant. 2025; 29(2):e70043.

PMID: 39981772 PMC: 11843590. DOI: 10.1111/petr.70043.

Prediction of Allograft Failure in Pediatric Kidney Transplant Recipients: A Validation Study of the Four-Variable Kidney Failure Risk Equation.

Nogueira Machado S, Freitas J, Moreira C, Teixeira A, Costa T, Faria M Cureus. 2024; 16(11):e72901.

PMID: 39624526 PMC: 11611478. DOI: 10.7759/cureus.72901.

Pediatric kidney transplantation in Europe, a clinical snapshot pilot.

Oomen L, Bootsma-Robroeks C, Bouts A, Carbonell Pradas M, Gander R, Kienzl-Wagner K Front Pediatr. 2024; 12:1432027.

PMID: 39513158 PMC: 11540619. DOI: 10.3389/fped.2024.1432027.

Predicting pediatric kidney transplant wait times: The unexplored landscape and pre-allocation transplant policies.

Engen R Pediatr Nephrol. 2024; 39(8):2275-2278.

PMID: 38302675 DOI: 10.1007/s00467-024-06308-6.

References

Gordillo R, Munshi R, Monroe E, Shivaram G, Smith J . Benefits and risks of protocol biopsies in pediatric renal transplantation. Pediatr Nephrol. 2018; 34(4):593-598. DOI: 10.1007/s00467-018-3959-6. View

Alberts V, Idu M, Legemate D, Laguna Pes M, Minnee R . Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int. 2014; 27(6):593-605. DOI: 10.1111/tri.12301. View

Van Arendonk K, Garonzik Wang J, Deshpande N, James N, Smith J, Montgomery R . Practice patterns and outcomes in retransplantation among pediatric kidney transplant recipients. Transplantation. 2013; 95(11):1360-8. PMC: 3674132. DOI: 10.1097/TP.0b013e31828c6d64. View

Politano V, Leadbetter W . An Operative Technique for the Correction of Vesicoureteral Reflux. J Urol. 2016; 197(2S):S94-S100. DOI: 10.1016/j.juro.2016.10.093. View

Thomas J . Etiopathogenesis and management of bladder dysfunction in patients with posterior urethral valves. Indian J Urol. 2011; 26(4):480-9. PMC: 3034052. DOI: 10.4103/0970-1591.74434. View

Kayler L, Zendejas I, Molmenti E, Chordia P, Schain D, Magliocca J . Kidney transplant ureteroneocystostomy: comparison of full-thickness vs. Lich-Gregoir techniques. Clin Transplant. 2012; 26(4):E372-80. DOI: 10.1111/j.1399-0012.2012.01655.x. View

Gillis K, Lees J, Ralston M, Glen J, Stevenson K, McManus S . Interaction between socioeconomic deprivation and likelihood of pre-emptive transplantation: influence of competing risks and referral characteristics - a retrospective study. Transpl Int. 2018; 32(2):153-162. DOI: 10.1111/tri.13336. View

Coorey G, Paykin C, Singleton-Driscoll L, Gaston R . Barriers to preemptive kidney transplantation. Am J Nurs. 2009; 109(11):28-37. DOI: 10.1097/01.NAJ.0000363348.29227.a9. View

Hermsen M, de Bel T, den Boer M, Steenbergen E, Kers J, Florquin S . Deep Learning-Based Histopathologic Assessment of Kidney Tissue. J Am Soc Nephrol. 2019; 30(10):1968-1979. PMC: 6779356. DOI: 10.1681/ASN.2019020144. View

10.

Morizane R, Lam A, Freedman B, Kishi S, Valerius M, Bonventre J . Nephron organoids derived from human pluripotent stem cells model kidney development and injury. Nat Biotechnol. 2015; 33(11):1193-200. PMC: 4747858. DOI: 10.1038/nbt.3392. View

11.

Fahmy L, Massie A, Muzaale A, Bagnasco S, Orandi B, Alejo J . Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation. Transplantation. 2016; 100(6):1294-8. PMC: 4820762. DOI: 10.1097/TP.0000000000001236. View

12.

Chebib F, Prieto M, Jung Y, Irazabal M, Kremers W, Dean P . Native Nephrectomy in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease. Transplant Direct. 2016; 1(10):e43. PMC: 4788702. DOI: 10.1097/TXD.0000000000000554. View

13.

Woolf A . Growing a new human kidney. Kidney Int. 2019; 96(4):871-882. PMC: 6856720. DOI: 10.1016/j.kint.2019.04.040. View

14.

Nieuwhof-Leppink A, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P . Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). J Pediatr Urol. 2021; 17(2):172-181. DOI: 10.1016/j.jpurol.2020.11.006. View

15.

Thongprayoon C, Kaewput W, Kovvuru K, Hansrivijit P, Kanduri S, Bathini T . Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation. J Clin Med. 2020; 9(4). PMC: 7230205. DOI: 10.3390/jcm9041107. View

16.

De Wall L, Oomen L, Glaap-Roeven F, Feitz W, Bootsma-Robroeks C . Outcome of a thorough screening of lower urinary tract function in all pediatric kidney recipients. Pediatr Transplant. 2020; 25(5):e13929. DOI: 10.1111/petr.13929. View

17.

Neschis D, Gutta R, Al-Qudah H, Bartlett S, Philosophe B, Schweitzer E . Intraoperative coil embolization reduces transplant nephrectomy transfusion requirement. Vasc Endovascular Surg. 2007; 41(4):335-8. DOI: 10.1177/1538574407302845. View

18.

McDonald R, Smith J, Ho M, Lindblad R, Ikle D, Grimm P . Incidence of PTLD in pediatric renal transplant recipients receiving basiliximab, calcineurin inhibitor, sirolimus and steroids. Am J Transplant. 2008; 8(5):984-9. DOI: 10.1111/j.1600-6143.2008.02167.x. View

19.

Danziger-Isakov L, Kumar D . Vaccination in solid organ transplantation. Am J Transplant. 2013; 13 Suppl 4:311-7. DOI: 10.1111/ajt.12122. View

20.

van den Heuvel M, van der Lee J, Cornelissen E, Bemelman F, Hoitsma A, Geskus R . Transition to the adult nephrologist does not induce acute renal transplant rejection. Nephrol Dial Transplant. 2009; 25(5):1662-7. DOI: 10.1093/ndt/gfp684. View