Fifty Years of Pediatric Kidney Transplantation: A Review

More than 13,000 pediatric kidney transplantations are performed worldwide each year. There have been dramatic changes in healthcare since the first pediatric transplantation in 1959 at the University of Oregon, Portland, including an increase in pre-emptive transplantations with grafts from living donors. While there have also been substantial improvements in graft survival, according to Loes Oomen, PhD, and colleagues in the Netherlands, there are still challenges associated with pediatric kidney transplantation.

The researchers conducted a non-systematic review to summarize how the understanding of pediatric kidney transplantation has evolved and improved since the first successful procedure in 1959, and to highlight areas where future research should focus to help resolve unanswered questions regarding pediatric kidney transplantation. The review was reported online in Frontiers in Pediatrics [doi.org/10.3389/fped.2022.856630].

The researchers compared existing literature with their own data on 411 single-center pediatric transplantations between 1968 and 2020 to identify discrepancies and characterize future challenges. Key issues for future care include innovations in immunosuppressive medications, improvements in medication adherence, focused donor selection with regard to both donor and recipient characteristics, improvement of surgical technique, and increased attention for lower urinary tract dysfunction (LUTD) and voiding behavior in all patients.

In conclusion, the authors said, “This overview of 50 years of care for pediatric kidney recipients revealed an impressive improvement of graft and patient survival. Important developments are the increased use of living donors, improved immunosuppressive therapy, and better peri-operative care. Still, many questions remain unanswered. In our center, pre-transplant treatment modality, donor age, and HLA mismatching did not affect graft survival which might advocate donor pool expansion. More large scale, multicenter studies are needed to confirm these findings.

“Since urological complications are more common in children, an active screening program for LUTD should be considered. Moreover, the optimal method for surgical vesico-ureteral anastomosis still needs to be established.”