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Pediatric Nephrology

, Volume 33, Issue 6, pp 1057–1068 | Cite as

Outcome of renal transplantation in small infants: a match-controlled analysis

  • Marcus Weitz
  • Guido F. Laube
  • Maria Schmidt
  • Kai Krupka
  • Luisa Murer
  • Dominik Müller
  • Bernd Hoppe
  • Anja Büscher
  • Jens König
  • Martin Pohl
  • Therese Jungraithmayr
  • Florian Thiel
  • Heiko Billing
  • Ryszard Grenda
  • Jacek Rubik
  • Michael M. Kaabak
  • Fatos Yalcinkaya
  • Rezan Topaloglu
  • Nicholas Webb
  • Luca  Dello Strologo
  • Lars Pape
  • Silvio Nadalin
  • Burkhard Tönshoff
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

These data suggest that RTx in low-weight children is a feasible option, at least in selected centers with appropriate surgical and medical expertise.

Keywords

Renal transplantation Infants Children Surgical complications Medical complications 

Notes

Acknowledgements

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.

Authorship

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.

Funding

The CERTAIN Registry is funded by a grant from the Dietmar Hopp Stiftung and grants from the pharmaceutical companies Astellas and Novartis.

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.

Ethical approval

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.

Supplementary material

467_2018_3895_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)
467_2018_3895_MOESM2_ESM.docx (91 kb)
ESM 2 (DOCX 91 kb)

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Marcus Weitz
    • 1
  • Guido F. Laube
    • 1
  • Maria Schmidt
    • 1
  • Kai Krupka
    • 2
  • Luisa Murer
    • 3
  • Dominik Müller
    • 4
  • Bernd Hoppe
    • 5
  • Anja Büscher
    • 6
  • Jens König
    • 7
  • Martin Pohl
    • 8
  • Therese Jungraithmayr
    • 9
  • Florian Thiel
    • 10
  • Heiko Billing
    • 11
  • Ryszard Grenda
    • 12
  • Jacek Rubik
    • 12
  • Michael M. Kaabak
    • 13
  • Fatos Yalcinkaya
    • 14
  • Rezan Topaloglu
    • 15
  • Nicholas Webb
    • 16
  • Luca  Dello Strologo
    • 17
  • Lars Pape
    • 18
  • Silvio Nadalin
    • 19
  • Burkhard Tönshoff
    • 2
  1. 1.Paediatric NephrologyUniversity Children‘s Hospital ZurichZurichSwitzerland
  2. 2.Department of Paediatrics IUniversity Children’s HospitalHeidelbergGermany
  3. 3.Paediatric Nephrology Dialysis and Transplant Unit, Department of Woman’s and Child’s HealthAzienda Ospedaliera–University of PadovaPadovaItaly
  4. 4.Paediatric NephrologyCharité Campus Virchow HospitalBerlinGermany
  5. 5.University Children’s HospitalBonnGermany
  6. 6.University Children’s HospitalEssenGermany
  7. 7.University Children’s HospitalMünsterGermany
  8. 8.Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center - University Freiburg, Faculty of MedicineFreiburgGermany
  9. 9.Department of Paediatric NephrologyChildren’s HospitalMemmingenGermany
  10. 10.University Children’s HospitalHamburg–EppendorfGermany
  11. 11.Paediatrics IUniversity Children’s HospitalTübingenGermany
  12. 12.Department of Nephrology, Kidney Transplantation and Arterial HypertensionChildren’s Memorial Health InstituteWarsawPoland
  13. 13.Boris Petrovsky National Research Centre of SurgeryMoscowRussia
  14. 14.Department of Paediatric Nephrology, Faculty of MedicineAnkara UniversityAnkaraTurkey
  15. 15.Department of Paediatric Nephrology, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  16. 16.Department of Paediatric Nephrology and NIHR Manchester Clinical Research FacilityUniversity of Manchester–Manchester Academic Health Science CentreManchesterUK
  17. 17. Renal Transplantation Unit, Bambino Gesù Children’s Hospital (OPBG)Institute for Scientific ResearchRomeItaly
  18. 18.Department of Paediatric NephrologyHannover Medical SchoolHannoverGermany
  19. 19.Department of General, Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany

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