| Registration of children for kidney transplantation | << Back.. |
| 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 |
1 Indications
Indications for paediatric renal transplantation are children with irreversible renal failure and a GFR that is less than 10-15 ml/min/1.73m². The majority of children will have already started dialysis, but 22% of grafts are performed pre-emptively¹.
Many centres will have a minimum size requirement of 10 kg or minimum age of 21 - 24 months for children undergoing transplantation, however, guidelines vary and some centres will undertake transplantation at an earlier age² ³.
2 Relative contraindications to transplantation
In contrast to adult practice, the vast majority of children with end stage renal failure will be suitable for transplantation. Relative contraindications to paediatric renal transplantation are the presence of malignancy within the previous two years, HIV infection, and elevated circulating anti-glomerular basement membrane antibodies. Renal transplantation is not carried out in the presence of ABO blood group incompatibility nor in the presence of anti-HLA antibodies against donor antigens. Consideration needs to be given to the quality of life following transplantation, therefore multi-organ failure and severe brain damage will in general preclude transplantation. Transplantation should be delayed for several months if there is ongoing active disease such as haemolytic uraemic syndrome or rapidly progressive glomerulonephritis. Patients with hepatitis B or C can proceed with transplantation in the absence of active liver involvement. Consideration needs to be given to re-transplantation if the original disease has already recurred in a previous graft.
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¹ The third annual report of The UK
Renal Registry, Dec 2000
² Najarian JS, Almond S, Gillingham KJ, Mauer M, Chavers
B, Nevins TE, Kahtan CE, Matas AJ. Renal transplantation in
the first five years of life. Kidney Int [suppl] 1993;44;S40-S4
³ Tyden G, Berg U, Bohlin AB, Sandberg J. Renal transplantation
in children less than two years old. Transplantation 1997;63:554-558