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  • Renal transplantation  (4)
  • Children  (2)
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  • 1
    Electronic Resource
    Electronic Resource
    Organ transplantation in children (1989)
    Springer
    Intensive care medicine 15 (1989), S. S76 
    Details
    ISSN: 1432-1238
    Keywords: Organ transplantation ; Kidney transplantation ; Heart transplantation ; Heart and lung transplantation ; Liver transplantation ; Small intestine transplantation ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Organ transplantations have opened a new field in medicine and particularly in pediatrics. The kidney was the first organ to be regularly transplanted and there are now more than 2000 children who have received a kidney graft. Cadaver kidneys or living-related donor (LRD) kidneys can be used since an adult kidney may be grafted in a young child. Cadaver graft survival exceeds 85% at 1 year in recent single centre reports and patient survival is above 95%, the results being even better with LRD. Some complications may be observed in the long term, such as bone osteonecrosis, hypertension or infections. Rehabilitation is generally remarkable and growth which remained abnormal in 1/3 of cases under conventional treatment seems to improve markedly with cyclosporin. In the future, the development of kidney transplantation could lead hopefully to a drastic decrease in the number of children on dialysis. Liver transplantation is now performed in children with biliary atresia and metabolic diseases. There is no age limit for grafting a liver, the only problem being to find a pediatric cadaver donor of similar size. It is also possible to use an adult liver after hepatectomy. There were 170 liver grafts recorded in children in Europe in December 1986, and the long-term survival thanks to cyclosporin is exceeding 80% in some units. Thanks to cyclosporin, programs of cardiac transplantation for children are rapidly developing. The main indications are gross-congenital cardiac malformations or severe functional abnormality not compatible with life. Newborns have been grafted with success. The only problem is also to find a suitable pediatric donor. At the end of 1984, there were 88 cadaver transplantations reported in children, and this number is growing rapidly. Survival is estimated above 70% at 1 year. Indications for heart and lung transplantation are more numerous than for the heart alone, including severe cardiac malformations with abnormality of pulmonary circulation and a number of pulmonary diseases. A close similarity in the size of donor and recipient is mandatory. The immediate results are generally good, but the final outcome remains under evaluation. First investigated in animals, small intestine transplantation has been added recently to the list of possible organ transplantations in children. Indications are extensive intestinal resections, or malformations. The initial results are encouraging, but the long-term outcome remains under evaluation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00260895
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of growth hormone in short children after renal transplantation (1998)
    Springer
    Pediatric nephrology 12 (1998), S. 437-446 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Human recombinant growth hormone ; Renal transplantation ; Rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. From 1991 to 1993, 90 children having received a kidney graft with a post-transplantation period of at least 12 months were included in a prospective study carried out in 18 French pediatric centers. After informed consent and randomization, children received recombinant human growth hormone (rhGH) (Genotonorm, Pharmacia peptide hormones) 30 U/m2 per week, either immediately on enrollment, for the treated group, or after 1 year of follow-up for the group serving as a control. After 1 year both groups were treated and we analyzed data during the subsequent years. Eighty-five children completed the 1-year study. Growth velocity was significantly increased by rhGH: 7.7 cm with a gain of +0.3 standard deviation score in the treated group versus 4.6 cm in the control group (P〈0.0001) during the 1st year. Four factors predicted response to therapy: growth velocity prior to GH therapy, glomerular filtration rate (GFR) at the start, mode of corticosteroid administration, and degree of insulin resistance. After 1 year we observed a moderate, significant decrease in GFR in both groups. Biopsy-proven acute rejection episodes were not significantly more frequent during the 1st year in the group of patients who received rhGH: 9 in 44 versus 4 in 46 patients. The patients who rejected did not differ in terms of age, renal function at the start, and type of immunosuppression, but history of rejection before GH treatment was discriminatory: 6 of 17 children with two or more episodes had a new rejection versus 1 of 22 who had no or only one episode (P=0.01). Glucose tolerance was not modified after 1 year of GH therapy. During the subsequent years of treatment a decrease in growth velocity was noted: 5.9 cm at 2 years, 5.5 at 3 years, and 5.2 cm at 4 years. In conclusion, GH is efficient for improving growth velocity in short transplanted children, inducing clear-cut but limited catch-up growth. The risk of rejection was shown only in patients with a prior history of more than one rejection episode.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050483
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  • 3
    Electronic Resource
    Electronic Resource
    Pretransplant blood transfusions with cyclosporine in pediatric renal transplantation (2000)
    Springer
    Pediatric nephrology 14 (2000), S. 451-456 
    Details
    ISSN: 1432-198X
    Keywords: Key words Blood transfusion ; Cyclosporine ; Renal transplantation ; Cytotoxic antibodies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Pretransplant transfusions were repeatedly shown to be associated with improved graft survival in the ”pre-cyclosporine era,” and have recently been shown to be beneficial in patients on modern immunosuppressive regimes. In an attempt to improve this transfusion effect and minimize the potential development of cytotoxic antibodies, we have given these transfusions, with concomitant cyclosporine cover, prior to transplantation. Ninety-two renal transplantations were performed in 91 children in the study group (group 1) and all received pretransplant transfusions with cyclosporine cover. Results were compared with a preceding group of 102 children (104 transplantations) who had received pretransplant transfusions without cyclosporine cover (group 2). There were 70 cadaver and 22 living-related donor (LRD) transplants in group 1, and 88 cadaver and 16 LRD transplants in group 2. Graft survival rates (1- and 5-year) for cadaver transplantation were 96% and 90% in group 1 compared with 78% and 64% in group 2 (P=0.001). For LRD transplantation, these figures were 95% and 87% in group 1 and 81% and 69% in group 2. There was no difference between the two groups in terms of age at transplantation, sex, donor age, HLA-A, -B, -DR mismatches, or cold and warm ischemia times. All cadaver graft recipients received quadruple, sequential immunosuppression post transplant. However, 9 patients in group 1 were changed to tacrolimus for recurrent rejection episodes. No patient developed persistent lymphocytotoxic antibodies post transfusion or side effects of cyclosporine. Cyclosporine can be safely given with whole blood prior to transplantation with no adverse effect and no sensitization. Graft survival was significantly improved in this group of patients and graft loss due to rejection was exceptional. This effect should be further evaluated in prospective studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050791
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  • 4
    Electronic Resource
    Electronic Resource
    Growth after renal transplantation: Correlation with immunosuppressive therapy (1991)
    Springer
    Pediatric nephrology 5 (1991), S. 143-146 
    Details
    ISSN: 1432-198X
    Keywords: Renal transplantation ; Growth ; Immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The growth data for children transplanted between 1973 and 1987 were analysed according to their immunosuppressive regimen. All patients treated before 1985 received conventional treatment (prednisone, azathioprine); 37% of the prepubertal children with a follow-up of longer than 2 years showed catch-up growth, and 30% of the pubertal children exhibited a normal adolescent growth spurt. Reduced renal function and corticosteroid treatment are the two main causes of growth delay. The children transplanted between January 1985 and September 1987 were given either triple therapy [cyclosporine (CsA), prednisone, azathioprine] or conventional treatment after randomisation. Growth data were significantly better with CsA. The mean height gain for prepubertal children was +0.24 SD/year on triple therapy and +0.14 SD/year on conventional therapy during the 1st year after transplantation; and 0.4 SD/year and 0 SD/year during the 2nd year (P〈0.05). The mean height gain for pubertal children was 5.6 cm/year on triple therapy and 3.6 cm/year on conventional therapy (P〈0.005). The patients on triple therapy also received a significantly lower cumulative dose of prednisone. Some selected patients on triple therapy were taken off prednisone 12 months after transplantation. All patients showed catch-up growth (+0.83 SD/year in prepubertal children, 7.2 cm/year in pubertal children). In conclusion, protocols including CsA and the lowest cumulative dose of steroid (with alternate-day or even steroid withdrawal) allow the best restoration of growth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00852872
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  • 5
    Electronic Resource
    Electronic Resource
    Acute pancreatitis in six non-transplanted uraemic children (1988)
    Springer
    Pediatric nephrology 2 (1988), S. 431-435 
    Details
    ISSN: 1432-198X
    Keywords: Chronic renal failure ; End-stage kidney disease ; Children ; Pancreatitis ; Haemodialysis ; Peritoneal dialysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten clinical episodes of acute pancreatitis (AP) occurred in six patients (mean age 10 years, range 3–15 years) with chronic renal failure (CRF) during a 9-year period (1977–1986). The underlying cause of CRF was vesicoureteral reflux (2); urethral valves (1); ureterohydronephrosis (1); nephronopthisis (1) and a haemolytic uraemic syndrome which occurred 12 years before (1). In all patients a diagnosis of AP was established both on clinical grounds and with a serum amylase level of 〉600 IU/1. In 3 patients laparotomy was performed because of suspected appendicitis. All patients required exclusive parentenral feeding (mean duration 25 days) and 2 patients had a partial pancreatectomy. No patient developed pancreatic pseudocysts, 2 patients experienced one relapse (3 and 21 months later) and 1 patient had two relapses and died. Mean duration of follow up was 3 years (range 1–10 years). Possible aetiological factors were: choledochal cyst (1); parotitis without a rise in mumps antibodies (1); familial dyslipidaemia but without AP in other family members (1), and aluminium intoxication with hypercalcaemia and convulsive encephalopathy treated with valproic acid in 1 patient. Severe hyperparathyroidism with radiological signs was absent in all patients. Transplantation had been performed either before AP in 2 patients (1 and 3 years before AP) or had followed AP in 1 patient (7 years after) without occurrence or relapse of AP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00853437
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Diabetes mellitus in patients with infantile cystinosis after renal transplantation (1999)
    Springer
    Pediatric nephrology 13 (1999), S. 524-529 
    Details
    ISSN: 1432-198X
    Keywords: Key words Infantile cystinosis ; Renal transplantation ; Diabetes mellitus ; Impaired glucose tolerance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Diabetes mellitus is a frequent long-term complication of infantile nephropathic cystinosis. We studied 44 cystinotic patients, aged 22.1±5.4 years, transplanted at a mean age of 11.3±2.5 years; 25% were treated with insulin at 20 years of age or 10 years after transplantation, and over half required insulin at latest follow-up. In comparison, diabetes mellitus occurred in only 1% of non-cystinotic transplanted patients. Sequential oral glucose tolerance tests (OGTTs) in these patients showed the progressive deterioration of glucose metabolism. All but 2 patients had an abnormal response at latest follow-up. The high doses of corticosteroid given after transplantation or during rejection episodes were responsible for transient insulin dependency. However, the development of impaired glucose tolerance and diabetes mellitus depended mainly on the cystinotic process, which developed slowly with time. The deterioration of glucose tolerance was correlated with a decreased early phase of insulin secretion, estimated from the plasma insulin level at 30 min of the OGTT, while there was no evidence of insulin resistance. The occurrence of diabetes mellitus correlated with a worsening of the vital prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050651
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