Deceased donor kidney transplanted in childhood functioning well after 52 years.

Autor: Spartà G; Pediatric Nephrology Unit, University Children's Hospital, Zurich, Switzerland., Hadaya K; Service of Nephrology and Hypertension, Geneva University Hospitals, Clinique Des Grangettes-Hirslanden, Geneva, Switzerland., Paunier L; Pediatric Nephrology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland., Girardin E; Pediatric Nephrology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland., Leumann E; Pediatric Nephrology Unit, University Children's Hospital, Zurich, Switzerland. e.leumann@swissonline.ch.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2023 Oct; Vol. 38 (10), pp. 3489-3492. Date of Electronic Publication: 2023 Mar 16.
DOI: 10.1007/s00467-023-05901-5
Abstrakt: Background: Kidney transplantation in children in 1970 was considered by many to be unethical, as long-term survival was minimal. It was therefore risky at the time to offer transplantation to a child.
Case Diagnosis/treatment: A 6-year-old boy with kidney failure due to haemolytic uraemic syndrome received 4 months of intermittent peritoneal dialysis followed by 6 months of haemodialysis until at 6 years and 10 months, he underwent bilateral nephrectomy and received a kidney transplant from a deceased 18-year-old donor. Despite moderate long-term immunosuppression of prednisone (20 mg/48 h) and azathioprine (62.5 mg/day), at the last visit in September 2022, he was well, normotrophic, with a serum creatinine of 157 µmol/l (eGFR 41 ml/min/1.73 m 2 ) and no haematuria, proteinuria or hypertension. Except for benign skin lesions due to azathioprine, and undergoing an aortic valve replacement and an aortic aneurysm repair in adulthood, the now 58-year-old man has had no major complications.
Conclusions: We speculate that stable and unmodified immunosuppressive therapy, started before the era of calcineurin inhibitors, the lack of significant rejection episodes, the absence of donor-specific antibodies, and the young donor age have contributed to maintaining exceptional long-term kidney transplant survival. Luck, a robust health system and an adherent patient are also important. To the best of our knowledge, this is the longest functioning kidney transplant from a deceased donor performed in a child worldwide. Despite its risky nature at the time, this transplant paved the way for others.
(© 2023. The Author(s).)
Databáze: MEDLINE
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