Recurrent Disease After Pediatric Kidney Transplantation

Abstract

Pediatric kidney transplantation is a lifesaving therapy for children with kidney failure. With modern immunosuppression, transplant rejection is as low as 11% in the first year posttransplant. Data from the United States Scientific Registry of Transplant Recipients (SRTR) reported improvements of one-year graft survival for transplants performed in 1987 versus 2010 from 81% to 97%, and 10-year graft survival for transplants performed in 1987 versus 2001 (47% versus 60%) (Pediatrics 133(4): 594-601, 2004). Transplant offers numerous quantifiable and non-quantifiable benefits over dialysis. But some diseases that cause end stage kidney diseases can recur after transplant. The effects of this disease recurrence on patient and kidney allograft health are often devastating. Recurrence of disease accounts for 7-8% of graft losses in pediatric kidney transplant recipients and is the fourth most common cause of graft loss after chronic rejection, acute rejection, and death with a functioning graft (Pediatr Nephrol 24:2097-2108, 2009). This chapter is focused on describing the incidence and pathogenesis of some of these diseases in greater detail and providing an updated literature review on potential preventive and therapeutic strategies for recurrent disease in the kidney allograft.