Outcome of renal transplantation in small infants: a match-controlled analysis
Infants with a body weight of less than 10 kg are often not considered to be suitable candidates for renal transplantation (RTx). The objective of this study was to evaluate this arbitrary weight threshold for pediatric RTx.
We conducted a multicenter, retrospective, match-controlled cohort study on infants weighing less than 10 kg at time of engrafting (low-weight group [LWG], n = 38) compared to a matched control group (n = 76) with a body weight of 10–15 kg, using data from the first 2 years post-transplant derived from the CERTAIN Registry.
Patient survival was 97 and 100% in the LWG and control groups, respectively (P = 0.33), and death-censored graft survival was 100 and 95% in the LWG and control groups, respectively (P = 0.30). Estimated glomerular filtration rate at 2 years post-transplant was excellent and comparable between the groups (LWG 77.6 ± 34.9 mL/min/1.73 m2; control 74.8 ± 29.1 mL/min/1.73 m2; P = 0.68). The overall incidences of surgery-related complications (LWG 11%, control 23%; P = 0.12) and medical outcome measures (LWG 23%, control 36%, P = 0.17) were not significantly different between the groups. The medical outcome measures included transplant-related viral diseases (LWG 10%, control 21%; P = 0.20), acute rejection episodes (LWG 14%, control 29%; P = 0.092), malignancies (LWG 3%, control 0%; P = 0.33) and arterial hypertension (LWG 73%, control 67%; P = 0.57).
These data suggest that RTx in low-weight children is a feasible option, at least in selected centers with appropriate surgical and medical expertise.
KeywordsRenal transplantation Infants Children Surgical complications Medical complications
We gratefully acknowledge the support of the CERTAIN Registry through a grant from the Dietmar Hopp Stiftung and through grants from the pharmaceutical companies Astellas and Novartis.
Study design, performance of the study, data analysis and writing of the manuscript: Marcus Weitz, Maria Schmidt, Silvio Nadalin, Guido F. Laube, Kai Krupka and Burkhard Tönshoff. Data collection and critical revision of the manuscript: Dominik Müller, Bernd Hoppe, Anja Büscher, Jens Koenig, Martin Pohl, Theresa Jungraithmayr, Florian Thiel, Lars Pape, Heiko Billing, Luisa Murer, Luca Dello Strologo, Jacek Rubik, Ryszard Grenda, Michael M. Kaabak, Rezan Topaloglu, Fatos Yalcinkaya, Nicholas Webb. All authors reviewed the manuscript, believed it represents valid work and approved it for submission.
Compliance with ethical standards
Conflict of interest statement
Marcus Weitz has participated on an Advisory Board for Astellas and has received lecture fees from Alexion. Burkhard Tönshoff has received research grants, travel grants and lecture fees and participated in advisory boards of Astellas, Bristol-Myers Squibb, Novartis and Roche. Heiko Billing has received travel grants by Astellas. Lars Pape has received research grants, travel grants and lecture fees, participated in advisory boards of Astellas and Novartis and has received research grants and travel grants from Sanofi. Michael Kabaak received research grants and lecture fees and participated in the advisory board of Astellas and Alexion. Luca DelloStrologo has received lecture fees from Novartis. Nicholas Webb participated on Advisory Boards for Abbvie, Astellas, Alexion and Raptor. The other contributing authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent to participate in the registry was obtained by all parents or guardians and patients when appropriate for their age.
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