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  • 1
    Electronic Resource
    Electronic Resource
    Respiratory syncytial virus infections in pediatric renal transplant recipients (1996)
    Springer
    Pediatric nephrology 10 (1996), S. 213-215 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Kidney transplant   ;   Infection   ;   Respiratory syncytial virus   ;   Rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Immunocompromised patients are considered at increased risk from respiratory syncytial virus (RSV) infection. We examined the incidence and outcome of RSV infection in pediatric renal transplant (Tx) recipients on chronic immunosuppressive therapy. Of 173 recipients transplanted between November 1985 and April 1993, 5 (3%) developed RSV infection (age range 11 – 39 months). Initial immunosuppression included prednisone, azathioprine, cyclosporine, and polyclonal antibody therapy. Time from Tx to onset of RSV infection was 1 day to 7 months. Symptoms included rhinorrhea, cough, tachypnea, retractions, fever, wheezing, and abnormal chest X-ray. Treatment included bronchodilator therapy, bronchial drainage, ribavirin, and mist tent. Azathioprine was transiently withheld for leukopenia during treatment in 2 recipients. Three recipients developed biopsy-proven acute rejection during (n=2) or immediately following (n=1) RSV infection; all responded to corticosteroid treatment. RSV infection is not commonly diagnosed in pediatric renal Tx recipients. The course of RSV infection in our patients did not differ from that reported in normal children. The possible association between RSV and acute rejection warrants further observation. When diagnosed early, RSV infection does not appear to be associated with increased mortality in pediatric renal Tx recipients. Larger numbers of recipients need to be studied to confirm these results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00862085
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  • 2
    Electronic Resource
    Electronic Resource
    De novo hemolytic uremic syndrome following renal transplantation (1990)
    Springer
    Pediatric nephrology 4 (1990), S. 62-64 
    Details
    ISSN: 1432-198X
    Keywords: Hemolytic uremic syndrome ; Renal transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of complete recovery of renal function in a patient with de novo hemolytic uremic syndrome (HUS) following renal transplantation. This 3-year-old girl had none of the factors known to contribute to the development of HUS in transplant recipients. This case illustrates the usefulness of renal biopsy in the accurate diagnosis and management of dysfunction in the allograft following renal transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00858442
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  • 3
    Electronic Resource
    Electronic Resource
    Effects of growth hormone on kidney function in pediatric transplant recipients (1995)
    Springer
    Pediatric nephrology 9 (1995), S. 176-181 
    Details
    ISSN: 1432-198X
    Keywords: Recombinant human growth hormone ; Kidney transplantation ; Rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent evidence suggests that treatment with recombinant human growth hormone (rhGH) after a successful kidney transplant improves the growth rate of children with short stature. We prospectively investigated eight children (6 boys, 2 girls), focusing on acute rejection episodes and changes in serum creatinine levels during rhGH treatment. The children (mean age 11.6±3.4 years) received rhGH daily (0.04–0.05 mg/kg subcutaneously). Seven patients completed at least 12 months (20±8 months) of rhGH treatment. Their mean serum creatinine level was 1.3±0.7 mg/dl 12 months before, and increased to 3.4±4.2 mg/dl after 12 months of rhGH treatment, but did not achieve statistical significance (P=0.06). Their mean calculated glomerular filtration rate was 58±20 ml/min per 1.73 m2 12 months before, and decreased to 38±21 ml/min per 1.73 m2 12 months before, and decreased to 38±21 ml/min per 1.73 m2 after 12 months of rhGH treatment, but did not achieve statistical significance (P=0.08). Of the seven patients, two developed acute rejection after 5 and 6 rejection-free years; three lost their grafts and returned to dialysis. These preliminary observations describe untoward renal events in children receiving rhGH treatment after a kidney transplant.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00860737
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  • 4
    Electronic Resource
    Electronic Resource
    Impact of age on renal graft survival in children after the first rejection episode (1996)
    Springer
    Pediatric nephrology 10 (1996), S. 474-478 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Renal transplantation   ;   Graft rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Infants are thought to be more immunoreactive and at a greater risk for developing irreversible rejection compared with older children. We investigated this by analyzing patient and graft survival rates, incidence of acute rejection, reversibility of acute rejection, development of a subsequent acute rejection, and incidence of graft loss due to rejection in 154 children (〈18 years of age) after primary renal transplantation. Most patients (n = 139) were treated with quadruple immunosuppression (antibody, azathioprine, prednisone, cyclosporine). Treatment of the first acute rejection episode (ARE) consisted of antibody and increased prednisone (68%) or increased prednisone alone (30%), and was not significantly different between the age groups. Transplants were from living donors (LRD) in 80% of cases. Patients were followed for at least 1 year (mean 58±30 months); 68% (105/154) of recipients experienced 1 or more ARE. The incidence of ARE was significantly lower in patients 〈2 years of age (45%) compared with patients 2 – 5 (76%, P = 0.01), 6 – 12 (78%, P = 0.005), and 13 – 17 (76%, P = 0.009) years of age. There was no significant difference in the 1-, 2- and 5-year patient or graft survival rates, the development of a subsequent acute rejection, or the incidence of graft loss due to acute rejection when analyzed by age group. These data suggest that the impact of an ARE is similar for younger and older children in our population receiving predominantly LRD transplants and quadruple immunosuppression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050142
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  • 5
    Electronic Resource
    Electronic Resource
    Respiratory syncytial virus infections in pediatric renal transplant recipients (1996)
    Springer
    Pediatric nephrology 10 (1996), S. 213-215 
    Details
    ISSN: 1432-198X
    Keywords: Kidney transplant ; Infection ; Respiratory syncytial virus ; Rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Immunocompromised patients are considered at increased risk from respiratory syncytial virus (RSV) infection. We examined the incidence and outcome of RSV infection in pediatric renal transplant (Tx) recipients on chronic immunosuppressive therapy. Of 173 recipients transplanted between November 1985 and April 1993, 5 (3%) developed RSV infection (age range 11–39 months). Initial immunosuppression included prednisone, azathioprine, cyclosporine, and polyclonal antibody therapy. Time from Tx to onset of RSV infection was 1 day to 7 months. Symptoms included rhinorrhea, cough, tachypnea, retractions, fever, wheezing, and abnormal chest X-ray. Treatment included bronchodilator therapy, bronchial drainage, ribavirin, and mist tent. Azathioprine was transiently withheld for leukopenia during treatment in 2 recipients. Three recipients developed biopsy-proven acute rejection during (n=2) or immediately following (n=1) RSV infection; all responded to corticosteroid treatment. RSV infection is not commonly diagnosed in pediatric renal Tx recipients. The course of RSV infection in our patients did not differ from that reported in normal children. The possible association between RSV and acute rejection warrants further observation. When diagnosed early, RSV infection does not appear to be associated with increased mortality in pediatric renal Tx recipients. Larger numbers of recipients need to be studied to confirm these results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00862085
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  • 6
    Electronic Resource
    Electronic Resource
    Complications by age in primary pediatric renal transplant recipients (1997)
    Springer
    Pediatric nephrology 11 (1997), S. 399-403 
    Details
    ISSN: 1432-198X
    Keywords: Key words:  Renal transplantation ; Hospital readmissions ; Infections
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract.   We asked whether pediatric renal transplant recipients, subgrouped by age, differed in the percentage and number of hospital readmissions and in the incidence of infectious complications post transplant. Between 1 August 1985 and 31 October 1993, a total of 164 patients 〈18 years of age underwent primary transplants, with cyclosporine-based immunosuppression, at the University of Minnesota. The percentage of readmissions (P = NS), the mean number of readmissions (P = NS), and the length of hospital stay during readmission (P = NS) did not differ significantly among age groups. The overall incidence of acute rejection was greater in those ≥2 years than those 〈2 years (P = 0.002), and in living donor recipients ≥2 years versus those 〈2 years (P = 0.02). The incidence of bacterial infection (〈2 years, 87%; 2 – 5 years, 72%; 6 – 12 years, 51%; 13 – 17 years, 40%) was greater in younger recipients (P = 0.0001). The most common bacterial infection in recipients ≤5 years was Clostridium difficile-associated diarrhea; in those 〉5 years, urinary tract infection. The overall incidence of viral infection did not differ among groups (P = NS). The most common viral infection in recipients ≤5 years was varicella and those 〉5 years, cytomegalovirus infection. Risk factors for infection in the first 6 months post transplant included age 〈2 years and Solu-Medrol treatment for acute rejection. In conclusion, young recipients 〈2 years of age at the time of transplant are at a higher risk for bacterial infection post transplant.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050304
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  • 7
    Electronic Resource
    Electronic Resource
    Risk factors for chronic rejection in pediatric renal transplant recipients – a single-center experience (1997)
    Springer
    Pediatric nephrology 11 (1997), S. 395-398 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Renal transplantation ; Acute rejection ; Chronic rejection ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤5 years, 〉5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (〈20 years, 20 – 49 years, 〉49 years), number of ABDR mismatches (0, 1 – 2, 3 – 4, 5 – 6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤50%, 〉50%), percentage PRA at transplantation (≤50%, 〉50%), dialysis pretransplant, preservation time 〉24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤5 mg/kg per day, 〉5 mg/kg per day), CsA dosage at 1 year posttransplant (≤5 mg/kg per day, 〉5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, 〉1), timing of AR (≤6 months, 〉6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P 〈0.0001, odds ratio 19.4), multiple ARE (〉1 vs. 1) (P 〈0.0001, odds ratio 30.1), and high percentage peak PRA (〉50%) (P 〈0.03, odds ratio 3.6).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050303
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  • 8
    Electronic Resource
    Electronic Resource
    Simultaneous pancreas-kidney transplant in two children with hemolytic-uremic syndrome (1997)
    Springer
    Pediatric nephrology 11 (1997), S. 485-487 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Pancreas transplantation ; Kidney transplantation ; Hemolytic uremic syndrome ; Diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Simultaneous pancreas-kidney (SPK) transplantation has rarely been performed in the pediatric population. This report describes successful SPK transplantation in a 12-year-old girl and a 14-year-old boy with renal and pancreatic insufficiency secondary to postdiarrheal hemolytic-uremic syndrome. All reported cases of pediatric SPK transplantation are reviewed. SPK transplantation is a feasible option in selected pediatric patients with combined pancreatic and renal insufficiency.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050322
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  • 9
    Electronic Resource
    Electronic Resource
    Delayed acute renal failure in post-transplant period in young children from unexplained etiology (1997)
    Springer
    Pediatric nephrology 11 (1997), S. 531-536 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Delayed acute renal failure ; Post-transplant period ; Unexplained etiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. This report describes six young children (5 male) who developed delayed acute renal failure (DARF) in the early post-kidney-transplant (Tx) period in the absence of acute rejection (AR) or other diagnosable conditions. These young children, aged 16.5 ± 3.1 (12–21) months [mean ± SD, (range)] and weighing 8.5 ± 1.7 (7.1 – 11.4) kg received a primary renal Tx (5 living-related donor, 1 cadaver) between 1984 and 1992. Immunosuppression included prednisone, azathioprine, and Minnesota antilymphocyte globulin (MALG, n = 5); one patient received cyclosporine and no MALG. Initially, all patients had good urine output (UO). They became systemically ill and abruptly developed diminished UO on post-operative day (POD) 6.5 ± 1 (4 – 8). DARF was accompanied by fever (39.1 – 40.4°C, n = 6), thrombocytopenia (platelets 〈100,000/mm3, n = 6), leukocytosis, or leukopenia (white cell count 〉20,000/mm3, n = 4 or 〈1,000/mm3, n = 1). Four patients had diarrhea. Three had ascites and one was surgically explored for suspected urinary leak. None showed significant urinary obstruction by renal ultrasound. Renograms showed intact blood flow. Renal biopsy showed tubular ectasia (n = 6), vascular congestion (n = 5), focal glomerular endothelial swelling (n = 4), and capillary thrombi (n = 3). None showed AR. Five patients required dialysis for 11 ± 4 (7 – 15) days. All patients survived. One patient, treated for suspected AR with the monoclonal antibody OKT3, developed shock and lost her graft on POD 12 due to vascular thrombosis. Renal functional recovery in the remaining five patients took 14 ± 5 (6 – 20) days and their serum creatinine at discharge was 0.7 ± 0.5 (0.3 – 1.6) mg/dl. We report DARF from undetermined etiology occurring in the first 2 weeks of renal Tx in young children. Treatment is supportive care including dialysis. Recognition of this complication will help avoid risky investigations or unnecessary treatment for rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050332
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  • 10
    Electronic Resource
    Electronic Resource
    Causes of kidney allograft loss in a large pediatric population at a single center (1994)
    Springer
    Pediatric nephrology 8 (1994), S. 57-61 
    Details
    ISSN: 1432-198X
    Keywords: Allograft loss ; Causes ; Large single-center pediatric population
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract At our institution, 521 kidney transplants were performed in 429 children (mean age 8.7±5.6-years) between 1969 and 1991. Of these transplants, 408 were primary, 113 were retransplants, 347 were living related, 171 were cadaver, and 3 were living nonrelated. Immunosuppression consisted of prednisone, azathioprine, and Minnesota antilymphocyte globulin (non-CSA) in 339 patients, total lymphoid irradiation in 8, and, more recently, cyclosporine (CSA) in addition in 168 patients. Average followup was 8.8±6.0 years. Actuarial graft survival in the non-CSA versus CSA groups at 1 year was 77.0% versus 85.7%; at 5 years, 59.6% versus 71.9%. Of 136 non-CSA patients, causes of graft loss at 5 years included: chronic rejection in 55 (40.4%), acute rejection in 27 (19.9%), recurrent disease in 16 (11.8%), technical complications in 8 (5.9%), infectious complications in 4 (2.9%), other causes in 5 (3.7%), and death with a functioning graft in 21 (15.4%). Of 40 CSA patients, causes of graft loss at 5 years included: chronic rejection in 16 (40.0%), acute rejection in 8 (20.0%), recurrent disease in 6 (15.0%), technical complications in 3 (7.5%), other causes in 2 (5.0%), and death with a functioning graft in 5 (12.5%). The causes of graft loss did not significantly differ in the non-CSA and CSA groups. Chronic rejection was the most common cause of graft loss in both groups. Research focusing on chronic rejection is needed to improve graft outcome in pediatric kidney transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00868263
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