Clinical characteristics and complications of kidney transplantation among an Egyptian pediatric cohort
Main Article Content
Keywords
kidney transplantation, pediatric, complications
Abstract
Background: kidney transplantation is the treatment of choice in children with end stage kidney disease. Acute rejection represents a major complication with high risk of graft loss. Hence, the use of immunosuppressive therapy is inevitable to prevent allograft rejection. However, the excess use of immunosuppressive drugs can increase the risk of post-transplant infections with higher morbidity and mortality. The judicious use of the immunosuppressive drugs is crucial to enhance the transplant outcomes. Tacrolimus is the backbone of immunosuppressive therapy in the recent era of kidney transplantation. However, it is associated with many side effects. Close clinical and laboratory monitoring of tacrolimus trough level and serum creatinine are essential in all patients.
Methods: Analysis of the clinical data of 83 kidney transplant recipients with follow up data as graft function, post-transplant complications as acute rejection and infections were documented. Tacrolimus adverse effects were reported during at least 36 months of follow up post-transplant.
Results: Acute rejection was encountered in 43.4 % and post-transplant infections in 41 % of the included cases in the current study. In addition, tacrolimus side effects occurred in 32.5 % of the cases.
Conclusion: close follow up of kidney transplant recipients is essential for early detection and prompt management of graft rejection and infectious complications.
References
1. Dharnidharka V. R., Fiorina P. & Harmon W. E. 2014. Kidney transplantation in children. New England Journal of Medicine, 371: (6), 549-558.
2. Gillen D., Stehman‐Breen C., Smith J., et al.2008. Survival advantage of pediatric recipients of a first kidney transplant among children
awaiting kidney transplantation. American Journal of Transplantation, 8: (12), 2600-2606.
3. Kramer A., Stel V. S., Tizard J., et al. 2009. Characteristics and survival of young adults who started renal replacement therapy during
childhood. Nephrology Dialysis Transplantation,24: (3), 926-933.
4. Talley L. & Stablein D. 2006. North American Pediatric Renal Trials and Collaborative Studies: NAPRTCS 2006 Annual Report.
5. Friedersdorff F., Koch T.-M., Banuelos-Marco B., et al. 2018. Long-term follow-up after paediatric kidney transplantation and influence
factors on graft survival: a single-centre experience of 16 years. Urologia internationalis,100: (3), 317-321.
6. Verghese P. S. 2017. Pediatric kidney transplantation: a historical review. Pediatric research, 81: (1), 259-264.
7. Haas M., Loupy A., Lefaucheur C., et al. 2019. 2017 Updates to the Banff Classification of Allograft Pathology.
8. Zarkhin V., Lovelace P. A., Li L., Hsieh S.-C. & Sarwal M. M. 2011. Phenotypic evaluation of Bcell subsets after rituximab for treatment of acute renal allograft rejection in pediatric recipients. Transplantation, 91: (9), 1010-1018.
9. De Serres S. A., Mfarrej B. G., Magee C. N., et al. 2012. Immune profile of pediatric renal transplant recipients following alemtuzumab
induction. Journal of the American Society of Nephrology, 23: (1), 174-182.
10. Allain‐Launay E., Roussey‐Kesler G., Ranchin B., et al. 2009. Mortality in pediatric renal transplantation: a study of the French pediatric kidney database. Pediatric transplantation, 13: (6), 725-730.
11. Fathallah-Shaykh S. A., Flynn J. T., Pierce C. B., et al. 2015. Progression of pediatric CKD of nonglomerular origin in the CKiD cohort.
Clinical Journal of the American Society of Nephrology, 10: (4), 571-577.
12. Fadel F. I., Bazaraa H. M., Badawy H., et al.2020. Pediatric kidney transplantation in Egypt: Results of 10‐year single‐center experience. Pediatric transplantation, 24: (6), e13724.
13. Naik R. H. & Shawar S. H. 2020. Renal transplantation rejection. StatPearls.
14. Gourishankar S., Hunsicker L. G., Jhangri G. S., Cockfield S. M. & Halloran P. F. 2003. The stability of the glomerular filtration rate after
renal transplantation is improving. Journal of the American Society of Nephrology, 14: (9), 2387-2394.
15. Tanné C., Roy P., Frobert É., Duncan A., Laurent A. & Cochat P. 2019. Cytomegalovirus infection in the first year after pediatric kidney
transplantation. Nephrologie therapeutique, 15: (1), 44-50.
16. Kasiske B. L., Zeier M. G., Chapman J. R., et al.2010. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney international, 77: (4), 299-311.
17. Ramanan P. & Razonable R. R. 2013. Cytomegalovirus infections in solid organ transplantation: a review. Infection chemotherapy, 45: (3), 260-271.
18. Schwartz G. J., Munoz A., Schneider M. F., et al.2009. New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology, 20: (3), 629-637.
19. Harambat J., Van Stralen K. J., Kim J. J. & Tizard E. J. 2012. Epidemiology of chronic kidney disease in children. Pediatric Nephrology, 27: (3), 363-373.
20. Ardissino G., Dacco V. & Testa S. 2003. Bonaudo 5, Appiani AC, Taioli E, et al. Epidemiology of chronic renal failure in children:
Data Irom the ItalKid project. 3ediatrics, 111: e382.
21. Fernandes A., Rocha L., Costa T., et al. 2014. Infections following kidney transplant in children: a single-center study. Open Journal of
Nephrology, 4: (03), 117.
22. Vats A. N., Donaldson L., Fine R. N. & Chavers B. M. 2000. Pretransplant Dialysis Status and Outcome of Renal Transplantation in North American Children: a Naprtcs Study12. Transplantation, 69: (7), 1414-1419.
23. Jain D., Haddad D. B. & Goel N. 2019. Choice of dialysis modality prior to kidney transplantation: does it matter? World journal of nephrology, 8: (1), 1.
24. Fadel F. I., Elshamaa M. F., Salah A., et al. 2016. Fas/Fas Ligand pathways gene polymorphisms in pediatric renal allograft rejection. Transplant immunology, 37: 28-34.
25. Amaral S., Sayed B. A., Kutner N. & Patzer R. E. 2016. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney international, 90: (5), 1100-1108.
26. Ghane Sharbaf F., Bitzan M., Szymanski K. M., et al. 2012. Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatric Nephrology, 27: (7), 1179-1188.
27. Niaudet P. & Boyer O. 2009. Idiopathic nephrotic syndrome in children: clinical aspects. Pediatric Nephrology.
28. Sert I., Yavascan Ö., Tugmen C., et al. 2013. A retrospective analysis of long-term graft survival in 61 pediatric renal transplant recipients: a single-center experience. Annals of Transplantation, 18: 497-504.
29. Shilbayeh S. & Hazza I. 2012. Pediatric renal transplantation in the Jordanian population: the clinical outcome measures during long-term follow-up period. Pediatrics Neonatology, 53: (1), 24-33.
30. Branco F., Almeida F., Cavadas V., et al. 2013. Pediatric kidney transplantation: a single center experience with 134 procedures. Transplantation Proceedings, 2013. Elsevier, 1057-1059.
31. do Nascimento Ghizoni Pereira L., Tedesco‐Silva Jr H. & Koch‐Nogueira P. C. 2021. Acute rejection in pediatric renal transplantation:
Retrospective study of epidemiology, risk factors, and impact on renal function. Pediatric transplantation, 25: (2), e13856.
32. Haas M., Kraus E. S., Samaniego-Picota M., Racusen L. C., Ni W. & Eustace J. A. 2002. Acute renal allograft rejection with intimal arteritis: histologic predictors of response to therapy and graft survival. Kidney international, 61: (4), 1516-1526.
33. Wu K., Budde K., Lu H., et al. 2014. The severity of acute cellular rejection defined by Banff classification is associated with kidney allograft outcomes. Transplantation, 97: (11), 1146-1154.
34. Mueller T., Resinger C., Ruffingshofer D., Arbeiter K., Balzar E. & Aufricht C. 2003. Urinary tract infections beyond the early posttransplant period in pediatric renal graft recipients. Wiener Klinische Wochenschrift, 115: (11), 385-388.
35. Mencarelli F. & Marks S. D. 2012. Non-viral infections in children after renal transplantation. Pediatric Nephrology, 27: (9), 1465-1476.
2. Gillen D., Stehman‐Breen C., Smith J., et al.2008. Survival advantage of pediatric recipients of a first kidney transplant among children
awaiting kidney transplantation. American Journal of Transplantation, 8: (12), 2600-2606.
3. Kramer A., Stel V. S., Tizard J., et al. 2009. Characteristics and survival of young adults who started renal replacement therapy during
childhood. Nephrology Dialysis Transplantation,24: (3), 926-933.
4. Talley L. & Stablein D. 2006. North American Pediatric Renal Trials and Collaborative Studies: NAPRTCS 2006 Annual Report.
5. Friedersdorff F., Koch T.-M., Banuelos-Marco B., et al. 2018. Long-term follow-up after paediatric kidney transplantation and influence
factors on graft survival: a single-centre experience of 16 years. Urologia internationalis,100: (3), 317-321.
6. Verghese P. S. 2017. Pediatric kidney transplantation: a historical review. Pediatric research, 81: (1), 259-264.
7. Haas M., Loupy A., Lefaucheur C., et al. 2019. 2017 Updates to the Banff Classification of Allograft Pathology.
8. Zarkhin V., Lovelace P. A., Li L., Hsieh S.-C. & Sarwal M. M. 2011. Phenotypic evaluation of Bcell subsets after rituximab for treatment of acute renal allograft rejection in pediatric recipients. Transplantation, 91: (9), 1010-1018.
9. De Serres S. A., Mfarrej B. G., Magee C. N., et al. 2012. Immune profile of pediatric renal transplant recipients following alemtuzumab
induction. Journal of the American Society of Nephrology, 23: (1), 174-182.
10. Allain‐Launay E., Roussey‐Kesler G., Ranchin B., et al. 2009. Mortality in pediatric renal transplantation: a study of the French pediatric kidney database. Pediatric transplantation, 13: (6), 725-730.
11. Fathallah-Shaykh S. A., Flynn J. T., Pierce C. B., et al. 2015. Progression of pediatric CKD of nonglomerular origin in the CKiD cohort.
Clinical Journal of the American Society of Nephrology, 10: (4), 571-577.
12. Fadel F. I., Bazaraa H. M., Badawy H., et al.2020. Pediatric kidney transplantation in Egypt: Results of 10‐year single‐center experience. Pediatric transplantation, 24: (6), e13724.
13. Naik R. H. & Shawar S. H. 2020. Renal transplantation rejection. StatPearls.
14. Gourishankar S., Hunsicker L. G., Jhangri G. S., Cockfield S. M. & Halloran P. F. 2003. The stability of the glomerular filtration rate after
renal transplantation is improving. Journal of the American Society of Nephrology, 14: (9), 2387-2394.
15. Tanné C., Roy P., Frobert É., Duncan A., Laurent A. & Cochat P. 2019. Cytomegalovirus infection in the first year after pediatric kidney
transplantation. Nephrologie therapeutique, 15: (1), 44-50.
16. Kasiske B. L., Zeier M. G., Chapman J. R., et al.2010. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney international, 77: (4), 299-311.
17. Ramanan P. & Razonable R. R. 2013. Cytomegalovirus infections in solid organ transplantation: a review. Infection chemotherapy, 45: (3), 260-271.
18. Schwartz G. J., Munoz A., Schneider M. F., et al.2009. New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology, 20: (3), 629-637.
19. Harambat J., Van Stralen K. J., Kim J. J. & Tizard E. J. 2012. Epidemiology of chronic kidney disease in children. Pediatric Nephrology, 27: (3), 363-373.
20. Ardissino G., Dacco V. & Testa S. 2003. Bonaudo 5, Appiani AC, Taioli E, et al. Epidemiology of chronic renal failure in children:
Data Irom the ItalKid project. 3ediatrics, 111: e382.
21. Fernandes A., Rocha L., Costa T., et al. 2014. Infections following kidney transplant in children: a single-center study. Open Journal of
Nephrology, 4: (03), 117.
22. Vats A. N., Donaldson L., Fine R. N. & Chavers B. M. 2000. Pretransplant Dialysis Status and Outcome of Renal Transplantation in North American Children: a Naprtcs Study12. Transplantation, 69: (7), 1414-1419.
23. Jain D., Haddad D. B. & Goel N. 2019. Choice of dialysis modality prior to kidney transplantation: does it matter? World journal of nephrology, 8: (1), 1.
24. Fadel F. I., Elshamaa M. F., Salah A., et al. 2016. Fas/Fas Ligand pathways gene polymorphisms in pediatric renal allograft rejection. Transplant immunology, 37: 28-34.
25. Amaral S., Sayed B. A., Kutner N. & Patzer R. E. 2016. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney international, 90: (5), 1100-1108.
26. Ghane Sharbaf F., Bitzan M., Szymanski K. M., et al. 2012. Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatric Nephrology, 27: (7), 1179-1188.
27. Niaudet P. & Boyer O. 2009. Idiopathic nephrotic syndrome in children: clinical aspects. Pediatric Nephrology.
28. Sert I., Yavascan Ö., Tugmen C., et al. 2013. A retrospective analysis of long-term graft survival in 61 pediatric renal transplant recipients: a single-center experience. Annals of Transplantation, 18: 497-504.
29. Shilbayeh S. & Hazza I. 2012. Pediatric renal transplantation in the Jordanian population: the clinical outcome measures during long-term follow-up period. Pediatrics Neonatology, 53: (1), 24-33.
30. Branco F., Almeida F., Cavadas V., et al. 2013. Pediatric kidney transplantation: a single center experience with 134 procedures. Transplantation Proceedings, 2013. Elsevier, 1057-1059.
31. do Nascimento Ghizoni Pereira L., Tedesco‐Silva Jr H. & Koch‐Nogueira P. C. 2021. Acute rejection in pediatric renal transplantation:
Retrospective study of epidemiology, risk factors, and impact on renal function. Pediatric transplantation, 25: (2), e13856.
32. Haas M., Kraus E. S., Samaniego-Picota M., Racusen L. C., Ni W. & Eustace J. A. 2002. Acute renal allograft rejection with intimal arteritis: histologic predictors of response to therapy and graft survival. Kidney international, 61: (4), 1516-1526.
33. Wu K., Budde K., Lu H., et al. 2014. The severity of acute cellular rejection defined by Banff classification is associated with kidney allograft outcomes. Transplantation, 97: (11), 1146-1154.
34. Mueller T., Resinger C., Ruffingshofer D., Arbeiter K., Balzar E. & Aufricht C. 2003. Urinary tract infections beyond the early posttransplant period in pediatric renal graft recipients. Wiener Klinische Wochenschrift, 115: (11), 385-388.
35. Mencarelli F. & Marks S. D. 2012. Non-viral infections in children after renal transplantation. Pediatric Nephrology, 27: (9), 1465-1476.
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Published
Mar 29, 2023
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How to Cite
Mai S Korkor, Tarek el-desoky, Youssef M Mosaad, Doaa M. Salah, & Ayman Hammad. (2023). Clinical characteristics and complications of kidney transplantation among an Egyptian pediatric cohort. Journal of Population Therapeutics and Clinical Pharmacology, 30(5), 117-125. https://doi.org/10.47750/jptcp.2023.30.05.014
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mai S Korkor, Tarek el-desoky, Youssef M Mosaad, Doaa M. Salah, & Ayman Hammad. (2023). Clinical characteristics and complications of kidney transplantation among an Egyptian pediatric cohort. Journal of Population Therapeutics and Clinical Pharmacology, 30(5), 117-125. https://doi.org/10.47750/jptcp.2023.30.05.014