Paediatric nephrology II

Abstract

Background: Transfer of pediatric kidney transplant recipients to adult care is considered as a risk factor of graft failure because of higher incidence of rejections and problematic compliance with therapy. The goal of our study is to evaluate kidney graft survival after transition from the only Czech pediatric transplant center (Motol University Hospital) to adult transplant center in Institute for Clinical and Experimental Medicine (IKEM). Methods: We retrospectively analyzed a group of 64 pediatric kidney transplant recipients, who underwent kidney transplant surgery in Motol University Hospital between 1987 and 2006, and after reaching adulthood were transitioned to adult transplant center in IKEM. The complete laboratory and clinical data over the period of 12 month before and 36 months after transition were obtained in 42 (65.6%) patients. Results: At the time of transplantation, the mean age of patients was 13.2 years (6-18 years), three patients underwent two kidney transplantations. At the time of transition, the mean age of patients was 20.6 years (17- 24 years). In nine patients (21.4%) the renal graft failed during the first 36 month and in 6 patients (14.2%) during the first 12 months after transition. In analyzed period, we observed graft failure in 7/13 (53.8%) patients with serum creatinine levels above 200 lM and in 3/29 (10.3%) patients with serum creatinine levels below 200 mum/l at the time of transfer. Chronic rejection was the main cause of graft failure with the mean graft survival of 12.5 years (6- 18 years). The non-compliance with therapy was clearly demonstrated in 3 (7.1%) patients. In one patient, non-compliance led to graft failure during 5 months after transition. Conclusion: The transfer of pediatric kidney transplant recipients to adult care is one of risk factors of graft failure. Regarding the specific attributes of this group of patients, the transition process should comprise both special medical and psychosocial care.