Kidney transplantation is the preferred treatment strategy for pediatric patients with end-stage renal disease (ESRD), and as recent studies support, preemptive transplantation before dialysis is required can further improve outcomes for young patients.1,2
The health effects of end-stage renal disease (ESRD) on pediatric patients re serious and well understood. The 5-year mortality rate for pediatric patients beginning ESRD treatment is up to 30 times that of healthy children.2
Pediatric patients with ESRD can experience frequent hospitalization, stunted growth, and negative academic and social outcomes, key measures of overall
quality of life.3
Congenital abnormalities often underlie pediatric ESRD, and the condition can be associated with bladder dysfunction and chronic infections of the urinary tract. The transition to adult care can be especially challenging and, among transplant recipients, carries an increased risk of graft failure. Although renal replacement therapy can be an important aspect of care for children with ESRD, the longer a pediatric patient is on hemodialysis before kidney transplant, the greater the patient’s risk of graft failure.2
Among patients on dialysis, the youngest pediatric patients have the lowest survival rates at 12, 24, and 36 months.2
Kidney transplantation boosts survival rates. Overall, pediatric kidney transplant patients experience a fourfold higher survival benefit over that offered by dialysis2
, and these patients show improvements in social and academic function.3
Pediatric patients who receive a living-donor kidney have even lower rates of graft failure and better survival rates than do those who received a deceased-donor organ.1,2,4
Pediatric patients who receive preemptive transplants, that is, patients transplanted before dialysis, have even better outcomes, particularly if they receive living-donor organs. In a sample of over 3,600 pediatric patients, those who had undergone a preemptive living-donor kidney transplant experienced a 93.8% graft survival rate at 5 years vs. 89.1% for nonpreemptive living-donor transplant and a 76.4% 5-year graft survival rate among those with a nonpreemptive transplant employing a deceased-donor organ.1
Improving access to living-donor kidneys is of vital importance to the care of pediatric patients with ESRD. Strategies to improve access include improving the identification of living donors, kidney paired exchange, and earlier referral of the pediatric patient with chronic kidney disease who is at high risk of developing end-stage renal disease that may require dialysis.5,6
1. Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end stage renal disease. Kidney Int. 2016;90(5):100-1108.
2. Kaspar CDW, Bholah R, Bunchman TE. A review of pediatric chronic kidney disease. Blood Purif. 2016;41:211-217.
3. Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol. 2016;31:1579-1591.
4. Chinnakotla S, Verghese P, Chavers B, et al. Outcomes and risk factors for graft loss: Lessons learned from 1,056 pediatric kidney transplants at the University of Minnesota. J Am Coll Surg. 2017;224(4):473-486.
5. Andre M, Huang E, Everly M, Bunnapradist S. The UNOS renal transplant registry: Review of the last decade. Clin Transpl. 2014:1-12.
6. Boehm M, Winkelmayer WC, Arbeiter K, Mueller T, Aufricht C. Late referral to paediatric renal failure service impairs access to pre-emptive kidney transplantation in children. Arch Dis Child. 2010;95(8):634-638.
When to Refer
University of Minnesota Health kidney specialists provide complete diagnosis and care for all kidney disorders affecting infants, children, and adolescents. Our physicians have been pioneers in the treatment of kidney failure, end-stage renal disease (ESRD), focal segmental glomerulosclerosis, and hereditary kidney diseases. We have one of the largest and most experienced kidney transplant programs
for children in the world, having performed over 1,000 transplants at University of Minnesota Masonic Children’s Hospital since the 1970s. Our care team includes experienced pediatric transplant surgeons, nephrologists, urologists, cardiologists, nurse coordinators, dietitians, and social workers dedicated to providing comprehensive support to children with kidney disorders and their families. Our pediatric transplant team offers the most innovative treatments available and strives to perform kidney transplants before dialysis is needed. When dialysis is necessary, our pediatric providers are experts at determining when and how to provide it and at helping families decide on the best course of treatment for their children.
Multidisciplinary, Collaborative Care
Children with ESRD need support to grow and develop alongside their peers. Experienced practitioners and an individualized approach to patient care provide the best outcomes for these patients. Our specialists tailor care to each patient and help each family choose the best treatments to restore their child’s health. Our dietitians bring special expertise to the nutritional management of ESRD in children and guide families in supporting their children’s nutritional needs. University of Minnesota Health Child-Family Life services staff help patients and families manage illness and hospitalization. Child-Family Life social workers teach coping skills and provide interventions that help children and parents understand and prepare for medical procedures. Our teams consider play and interaction with others an essential part of treatment.
For a copy of the University of Minnesota Health Mother’s and Children’s Specialty Directory, contact Outreach Manager Cindy Koslowski at 612-672-4184 or firstname.lastname@example.org.
For general referral information, Visit MHealth.org/KidsRefer
To find current clinical trials available through M Health providers, visit studyfinder.umn.edu