Living related paediatric renal transplantation
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| ANNEX A | Paediatric renal transplantation |
| ANNEX B | Listing for paediatric cadaveric renal transplantation |
| ANNEX C | Pre-emptive transplantation |
| ANNEX D | Living related paediatric renal transplantation |
The results for living related paediatric renal transplantation are superior to cadaveric transplantation at all ages, particularly in the very young recipient1,2. Living related donation generally involves parents, but other relatives can also be considered. Living unrelated donation can also be considered.
The incidence of living related donation varies from country to country. In the UK the figure is 16 % 3, whereas in North America 49% of paediatric transplants are from living donors2, and in Scandinavia the figure is as high as 86%4.
For many families an advantage of living related donation is that it allows a degree of control over the timing of surgery. It also allows all required personnel to be present at the operation, and the child and donor to be in the best possible health. Other advantages of living related donation are that pre-emptive transplantation is more easily performed, the incidence of acute tubular necrosis is reduced5, and graft survival improved6,7. The disadvantage of living related donation is that one of the child's carers becomes a patient themselves, leaving the other carer with two dependants to look after in addition to any other siblings.
The decision for cadaveric versus living related donor transplantation depends on individual patient circumstances. For children placed on the cadaveric waiting list, avoidance of non-inherited parental antigens will allow living related transplantation to be considered in the future.
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1Schurman
SJ, McEnery PT. Factors influencing short-term and long-term
pediatric renal transplant survival. J Pediatr 1997;130:455-462
2Seikaly
M, Ho PL, Emmett L, Tejani A. The 12th report of the North
American Pediatric Renal Transplant Cooperative Study: renal
transplantation from 1987 through 1998. Pediatr Transplantation
2001;5:215-231
3Renal
Transplant Audit 1984-1993, UKTSSA Bristol, 1995
4Ehrich
JHH, Loirat C, Brunner FP. Report of management of renal failure
in children in Europe. Nephrol Dial Transplant 1992;7:36
5Warady
BA, Hebert D, Sullivan EK, Alexander SR, Tejani A. Renal transplantation,
chronic dialysis, and chronic renal insufficiency in children
and adolescents. The 1995 Annual Report of the North American
Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol
1997;11:49
6Warady
BA, Hebert D, Sullivan EK, Alexander SR, Tejani A. Renal transplantation,
chronic dialysis, and chronic renal insufficiency in children
and adolescents. The 1995 Annual Report of the North American
Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol
1997;11:49
7Broyer
M, on behalf of the EDTA registry committee. Kidney transplantation
in children. Data from the EDTA registry. Transplant Proc
1989;21:1985
