Childhood kidney disease is a critical issue affecting millions worldwide, including children at early ages. Encouraging education, early detection, and a healthy lifestyle is key in battling preventable kidney diseases in children. Treatment for inborn and acquired kidney disorders is essential. Renal transplant plays a significant role in treating end-stage renal disease in children, with varying incidence rates globally. Understanding the epidemiology, immunosuppression, and outcomes in pediatric renal transplantation is vital. Monitoring trends and disparities in access to pediatric renal transplant is crucial for improved healthcare outcomes in children.
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Presentation Transcript
Kidney disease affects millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.
Mini Michael, MD, MMed (Clin Epi) Texas Children s Hospital, Baylor College of Medicine Jodi M. Smith, MD, MPH Seattle Children s Hospital, University of Washington School of Medicine
Introduction Epidemiology Immunosuppression Outcome: graft and patient survival Unresolved issues in Pediatric Renal Transplantation ( Global Inequalities in Access to Pediatric Summary and future Introduction Epidemiology Immunosuppression Outcome: graft and patient survival Unresolved issues in Pediatric Renal Transplantation (RTx Global Inequalities in Access to Pediatric RTx Summary and future RTx) ) RTx
Renal transplant is the optimal treatment for children with end-stage renal disease (ESRD) Incidence of ESRD in children varies throughout the world United States: ~14.8 cases per million Japan: ~ 4 cases per million Europe: ~ 8.3 cases per million but varies greatly among countries Developing world: Limited data Available estimates range from 3.4 pmcp (per million children population) in Turkey to a high of 35 pmcp in Kuwait Higher incidence in US may be due to earlier initiation of renal replacement therapy
NAPRTCS (North American Pediatric Renal Trials and Collaborative Studies) Annual Report 2014: Gender: Males 59% Race: White 59%, Black 17% and Hispanics 17% Age at transplant: age groups in years: 0-1: 5%; 2-5: 15%; 6-12: 32%; 13-17: 39% and >18 : 8% Most common primary diagnosis: Aplastic/hypoplastic/dysplastic kidneys (in 15.8%) Obstructive uropathy (in 15.3%) Focal segmental glomerulosclerosis (FSGS) is the third most common (11.7%) and continues to be the most prevalent acquired renal disease.
50% of all transplants have involved a deceased donor (DD) source, 40% came from a parent and 10% from other living donors (LD) Advantages of living donor renal transplant Pre-emptive transplantation Fewer rejection episodes Incidence of delayed graft function is lower Better graft survival Better graft function
Three general approaches: 1. To deplete circulating lymphocytes by destroying them 2. To use an inhibitor of lymphocyte activation (cyclosporine or tacrolimus) 3. To use various metabolic inhibitors (azathioprine, mycophenolate mofetil [MMF]) to interfere with lymphocyte proliferation essential for amplification of the response
Medication non-adherence Major cause of rejection and graft failure Adolescents with poor social support more affected Recurrence of FSGS post-transplant Results in graft failure in >60% Limited prevention/treatment options High PRA: Major focus of new kidney allocation system Recipients with CPRA of >80% receive additional priority points Recipients with CPRA of 98, 99 and 100% receive local, regional, and national priority, respectively Transplant in small children
Pediatric RTx performed in >60 countries worldwide but may cover no more than 10 % of global needs In US, pediatric RTx incidence rate was >10 pmarp (per million age related population) in 2012 In developing world, incidence rates of pediatric RTx depend on country income <1 2 pmarp in Pakistan, Arab countries, and South Africa <4 pmarp in Brazil Suggests a limited number of ESRD children have access to transplant Access to pediatric RTx varies substantially within same country Transplant outcome is generally poorer in low-income countries
Renal transplant is the optimal treatment for children with ESRD Living donor RTx has superior graft and patient survival Non-adherence is a major cause of graft failure Adolescents with poor social support more affected Major challenge is to reduce the inequality gap in access to optimal care for children with ESRD especially renal transplant worldwide World Kidney Day 2016, dedicated to children, will help to deliver this message to governments, health-policy makers, the medical community, and the public at large
Your pediatric nephrology community continues to work hard to improve clinical care, foster education, and advance the science regarding kidney disease in children! We appreciate your support and all you do for children s health care! Your pediatric nephrology community continues to work hard to improve clinical care, foster education, and advance the science regarding kidney disease in children! We appreciate your support and all you do for children s health care!
