SP721PAEDIATRIC KIDNEY TRANSPLANT PROGRAM IN KAZAKHSTAN

Abstract

Introduction and Aims: In Kazakhstan the prevalence of renal replacement therapy in children with end stage renal disease (ESRD) was 6 per million of the age-related population in 2013. Kidney transplantation is the best way to reach the medical and social rehabilitation of children with ESRD. Paediatric kidney transplant program in Kazakhstan was launched in 2012 in Astana. The aim of this study is to evaluate the results of the renal transplantation in children in Kazakhstan in the period from 2012 to 2015. Methods: We have conducted a retrospective analysis of the 29 transplanted children under the age of 18 who received kidney transplants in Astana during 2012-2015 years within paediatric kidney transplant program. Results: Mean age of the transplanted children was 11.2 years (Standard Deviation (SD) 3.9). Girls accounted for 69% of all recipients (n=20). The main primary renal diseases which caused ESRD were congenital anomalies of the kidney and urinary tract (44%) and glomerulonephritis (39%). 21 patients (72%) received a kidney transplant of the living donor from their relatives, while 8 children (28%) received a renal transplant from a deceased donor. Median waiting time was 1 year (Interquartile Range 0.5-2.5). Majority of children (47 %) received peritoneal dialysis (PD) before getting transplantation, 28% - haemodialysis (HD), 10% - PD and HD and 15% received pre-emptive transplantation. All children underwent immunosuppressive therapy consisted of induction therapy with monoclonal antibodies (Basiliximab (Simulect)) and Anti-thymocyte immunoglobulin (Thymoglobuline) and primary therapy with Calcineurin inhibitors (Tacrolimus or Cyclosporine), Mycophenolic acid (Cell-Cept) and glucocorticoids (Prednisolone or Methylprednisolone). Surgery complications after kidney transplantation were in 6 children (21%). Out of them 4 patients experienced chylorrhea, 1 child had the failure of the ureter (necrosis) and another child had bleeding. Mean follow-up time was 1.4 years (SD 0.9) resulting in total of 43 patient-years. Two patients died (7%). Mortality rate was 4.7 per 100 patient-years. Graft loss occurred in one child. Eight patients had graft dysfunction, the causes of which in most cases was infection (4 children). One-year patient and graft survival was 94% and 97% respectively. Three-year patient and graft survival was 95% ?85% respectively. Conclusions: assessing the experience of the first 29 transplanted children in Astana from 2012 to 2015, we can conclude that all the efforts that have been made for the implementation of this program have been successful. However, there are number of issues that require further consideration, such as allowing nephrologists to use protocols with minimal immunosuppressive support (early cancellation of steroids), carrying out a kidney transplantation in children with incompatible ABO system, increasing the number of cadaveric transplantation and the introduction of post-mortem donation for children.