Key Lessons from Sixty Years of Pediatric Kidney Transplants – Better Drugs and Living Donors Increase Survival Rate

September 20 2022

Living donors, fewer infections, and better medicines have greatly increased the chances of survival after kidney transplantation in children over the past 60 years. The quality of life of children who received kidneys from a donor also improved. Radboudumc has been specializing in pediatric kidney transplants for decades and does a lot of research on the best treatment.

In 1959, a child’s first kidney transplant was performed, and today about 1,300 children worldwide receive a new kidney each year. It has become a successful treatment when the kidneys stop working properly and acute kidney failure occurs. Transplanted kidneys today work better than they did in the early days, when only 42% of kidneys were still working after five years. Now 93% of patients still have a working donor kidney after five years. Their quality of life has also improved dramatically.

The fact that things are going so much better is partly due to better drugs that suppress the immune system. If patients do not take their medication, the immune system attacks the new kidney, resulting in rejection. Today we have much better medicines at our disposal than in the past. This is the main reason for improving donor kidney survival’, says Loes Oomen. She is a medical researcher in the Department of Urology at Radbodomic. She and her colleagues conducted a large study of the development of kidney transplants in children.

This research, published in Frontiers in Pediatrics, shows that the type of donor has changed. Most children who get a new kidney, especially in the Netherlands, receive it from a living donor. Often from a parent. ‘This has many advantages.’ The parents are often young and healthy, the operation can be planned in advance, and there is usually a good genetic match, says Omen. “A good genetic match reduces the chance of rejection.”

Radbodomic specializes in pediatric kidney transplantation

Radboudumc Amalia Children’s Hospital is one of three Dutch centers where children’s kidney transplants are performed. Since 1968, more than 400 children have received a new kidney here. The developments are similar to those in the rest of the world. In the Netherlands, only doctors at Radboudumc perform kidney transplants on children under three years old. However, the donated kidney is placed in the abdominal cavity, due to the lack of sufficient space in the pelvis.

Preventing re-implantation

Are we where we want to be? Oomen: “We are pleased with the developments. Major steps have also been taken in the multidisciplinary care of surgery. But we want to further improve the care of these patients. The main challenge is adherence to treatment: we note that adolescent children in particular do not always take their medication. Rejection may result. A new transplant is an option, but research shows it’s best prevented: Reimplantation generally produces worse outcomes for patients.

To prevent dialysis or not?

How do we find the most suitable donor and how do we determine the appropriate time for transplantation? Are you waiting for the most suitable donor with risk of dialysis or not? Oomen would like an answer to these questions. Our knowledge of DNA matching helps us with this. We also know that the age of the donor has an effect.

Research from Nijmegen previously showed that the bladders of children with a new kidney do not always function properly. There is also another challenge there. New developments, such as using artificial intelligence, combining patient data (as in the European context in the European health data space) or developing kidney organelles for drug research, are interesting avenues for further research. Watch a Kidney Foundation video on the development of Radboudumc’s kidney organelles here.

About the publication in Frontiers in Pediatrics

This article appeared in Frontiers in Pediatrics: Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades – Loes Oomen, Charlotte Bootsma-Robroeks, Elisabeth Cornelissen, Liesbeth de Wall, and Wout Feitz. DOI: 10.3389 / fped.2022.856630.

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