ESPN 53rd Annual Meeting

ESPN 2021


 
Clinical outcome after Renal Transplantation in Small Children (< 15 kilos): The Dutch experience
MIKE KEIZER 1 MARLIES CORNELISSEN 2 MANDY KEIJZER-VEEN 3 ANTONIA BOUTS 1 HUIB DE JONG 4

1- EMMA CHILDREN’S HOSPITAL, AMSTERDAM UNIVERSITY MEDICAL CENTER, AMSTERDAM, THE NETHERLANDS
2- AMALIA CHILDREN’S HOSPITAL, ST RADBOUD HOSPITAL, NIJMEGEN, THE NETHERLANDS
3- WILHELMINA CHILDREN’S HOSPITAL, UNIVERSITY MEDICAL CENTER UTRECHT, UTRECHT, THE NETHERLANDS
4- ERASMUS MC-SOPHIA CHILDREN’S HOSPITAL, ROTTERDAM, THE NETHERLANDS
 
Introduction:

In the smallest recipients (<15 kg) with end-stage-renal-disease (ESRD), kidney transplantation is a delicate task. We recently conducted a systematic review in which we showed that after an increase in graft survival in the early era, a stabilisation of graft survival is seen in recent years (under review). Although the better immunosuppressants have given great improvement in graft survival in the past, we hypothesize that their side effects (e.g. nephrotoxicity and infections) prevent further improvement. The current study investigates the clinical outcome of small children in the Netherlands, focussing on long-term post-transplantation complications (e.g infection, immunosuppression side effects and rejection) and relate these complications to the immunosuppression protocol used. 

Material and methods:

All children having received a renal transplantation in the Netherlands with a weight of 15 kilograms or less were included. Data regarding graft survival were obtained from the Dutch Organ Transplantation Registry. Other variables were extracted from reviewing medical charts. 

Results:

We included 73 transplantations performed from 1989 through 2020, of which 37 received a corticosteroid-sparing-protocol (TWIST) and 46 received a TRIPLE- immunosuppression-protocol. Overall, 5-years graft survival improved from 46% in the 70-80’s, to 84% in the 90-00’s and 96% in most recent era. Our analysis will focus on factors that are potentially associated with the recent stabilisation in graft survival (infections rate, immunosuppression side effects and rejection) and will be analysed for both immunosuppression groups.

Conclusions:

Our preliminary results show that clinical outcome after renal transplantation has improved over the years. However, the burden of (viral) infections and nephrotoxicity have grown, which could have a negative effect on recent graft survival data. Small children should have our special attention for two reasons. Firstly, at time of kidney transplant they are naive to most common (viral) infections. Secondly, with a lifelong immunosuppressant treatment ahead, they are more prone to side effects.