Andreea Mirela Caragea1,2, Bogdan-Mihai Cristea1, Maria Tizu1, Bogdan Calenic1, Secil Omer1, Ion Maruntelu1,2 and Ileana Constantinescu1,2*
1"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
2Centre for Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania
Aim: Understanding the aspects of transplantation immunology is essential for the personalized management of pediatric renal graft recipients. Kidney graft rejection represents an inflammatory reaction that occurs after transplantation, which is characterized by a cellular and humoral attack on the graft. Therefore, in order to optimize the medical approach of transplanted children, it is important to assess the immunological risk to which the child is exposed after transplantation. This work shows our experience in pediatric kidney transplantation. Methods: We analyzed retrospectively data from kidney transplanted children, between 2014- 2018 in Fundeni Clinical Institute, Bucharest. Data collection included age of the patient, the pathology that required a kidney transplant, blood group testing, immunosuppression regimen, HLA genotyping, anti-HLA antibodies, virology screen and cross matching. Donor type was also analyzed. Results: During the study period the transplant was performed from 23 living related donors and 4 cadaveric donors. Of the 26 haploidentical patients, there were 20 males and 6 females. The mean age at transplantation was 12 years. The most common diagnosis was congenital anomalies of the kidney and urinary tract in 53.85% of patients. More than half of the patients were on dialysis before transplantation, and only 30.77% received preemptive renal transplantation. From 26 children, five had an episode of acute or chronic rejection. And of these 5 children with an episode of acute or chronic rejection, 3 were younger children and two older children. There was a statistically significant difference in acute rejection between the 5-year-old and over-5-year-old patients (p=0.001). Acute rejection was more common in 5-year-olds. Regarding the type of donor (related donor versus cadaveric donor) no statistically significant difference was found in terms of rejection. Instead, there were statistical differences between the types of donor in terms of the rate of post-transplant complications. Surgical complications were more common in cadaveric donor transplantation than in related donor transplantation (p=0.0001). Detection of anti-HLA antibodies was performed at the time of registration on the waiting list and then after transplantation every three months. All the patients had negative antibodies to class I and class II throughout the follow-up period posttransplantation. No patients died during the follow-up period. Cross-match tests were negative for all patients. Conclusion: Improved HLA matching between donor and recipient, the absence of anti HLA antibodies and preemptive kidney transplantation are essential factors for long-term good quality life of kidney transplanted children.
Kidney transplantation; Pediatrics; Transplantation immunology
Caragea AM, -Mihai Cristea B, Tizu M, Calenic B, Omer S, Maruntelu I, et al. Kidney Transplantation in Children: Post-Transplantation Challenges and Management - Single Center Experience. Clin Surg. 2021; 6: 3320..