Short-Term Outcomes of Pediatric Renal Transplantation in Nigeria; A Single-Center Experience Pediatric renal transplantation in Nigeria
Journal of Pediatric Nephrology,
Vol. 9 No. 4 (2021),
10 November 2021
,
Page 1-9
https://doi.org/10.22037/jpn.v9i4.35429
Abstract
Background and Aim: Renal transplantation (RT) is the preferred treatment modality for children with end-stage kidney disease (ESKD). Unfortunately, RT remains inaccessible for children with ESKD in resource-constrained countries. This case-series describes a short-term follow-up of RT in three children in the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria.
Methods: The immediate allograft function (IAF), allograft functions and recipients’ survival at 6-24 months of follow-up of three pediatric ESKD patients from January 2018 to January 2020 were described. Allograft functions were assessed using serum creatinine and Doppler ultrasound scan. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy.
Results: Recipients including two males and one female were 9-17 years (mean age: 12 years). Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of ESKD in recipients seen over 24 months, 6 months, and 6 months, respectively. The female recipient had lupus nephritis. The IAF was excellent in all the cases. All the three children are alive with good allograft functions at the end of their respective follow-up period.
Conclusion: This case-series showed that a successful pediatric RT program is feasible in a resource-constrained setting like Nigeria.
Keywords:
- Pediatric
- Renal Transplantation
- Resource-Constrained Countries
- Nigeria
How to Cite
1.
Anigilaje EA, Olatise O, Kextero M, Martins I. Short-Term Outcomes of Pediatric Renal Transplantation in Nigeria; A Single-Center Experience: Pediatric renal transplantation in Nigeria. J Ped Nephrol [Internet]. 2021 Nov. 10 [cited 2023 Dec. 3];9(4):1-9. Available from: https://journals.sbmu.ac.ir/jpn/article/view/35429
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38. Charmaya O, Moudgil A. Hypertension in the Pediatric Kidney Transplant Recipient. Front Pediatr 2017;5:86
39. Vlahakos DV , Marathias KP , Agroyannis B. Madias NE. Posttransplant erythrocytosis. Kidney Int 2003; 63(4):1187-94.
40. Vishnu P, Moreno Vanegas Y, Wadei HM, et al Post-transplant erythrocytosis refractory to ACE inhibitors and angiotensin receptor blockers. Case Reports 2018;2018:bcr-2018-224622
41. McEnery PT, Nathan J, Bates SR, Daniels SR. Convulsions in children undergoing renal transplantation. J Pediatr 1989;115(4):532–6.
42. Lina P, Tiana X , Wang X. Seizures after transplantation. Eur J Epilep 2018:61:177-185.
43. Drake K, Nehus E, Goebel J. Hyponatremia, hypo-osmolality, and seizures in children early post-kidney transplant. Pediatr Transpl 2015;19(7):698–703
44. Vernon HJ, Sperati CJ, King JD, Poretti A, Miller NR, Sloan JL, et al. A detailed analysis of methylmalonic acid kinetics during hemodialysis and after combined liver/kidney transplantation in a patient with mut (0) methylmalonic acidemia. J Inherit Metab Dis 2014;37(6):899–907.
45. Khalil MAM, Khalil MAU, Khan TFT, Tan J Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians. J Transplant 2018, Article ID 9429265, 22 pages
46. Emiroğlu R, Moray G, Sevmiş S, Sözen MH, Bilgin N, Haberal M. Long-term results of pediatric renal transplantation at one center in Turkey. Transplant Proc 2005;37:675-8.
2. Murray JE. The first successful organ transplants in man. J Am Coll Surg 2005; 200:5-9.
3. Miller LC, Lum CT, Bock GH, Simmons RL, Najarian JS, Mauer SM. Transplantation of the adult kidney into the very small child. Technical considerations. Am J Surg 1983;145:243–7.
4. Cochat P, Martin X, Floret D, et al. Successful cadaveric renal transplantation in small children. Transplant Proc 1994;26:271.
5. Miller LC, Bock GH, Lum CT, Najarian JS, Mauer SM. Transplantation of adult kidney into the very small child: long-term outcome. J Pediatr 1982;100: 675–80.
6. Davis ID, Chang PN, Nevins TE. Successful renal transplantation accelerates development in young uremic children. Pediatrics 1990;86: 594–600.
7. Crittenden MR, Holliday MA, Piel CF, Potter DE. Intellectual development of children with renal insufficiency and end stage disease. Int J Pediatr Nephrol 1985;6:275–80.
8. Fine RN, Brennan LP, Edelbrock HH, Riddell H, Stiles Q, Lieberman E. Use of pediatric cadaver kidneys for homotransplantation in children. JAMA 1969;210:477–84.
9. Dharnidharka VR, Fiorina P, Harmon WE. Kidney Transplantation in Children. N Engl J Med 2014; 371:549-58.
10. Verghese PS. Pediatric kidney transplantation: a historical review. Ped Research 2017 ; 18(1): 259-64.
11. Cho MH. Pediatric kidney transplantation is different from adult kidney transplantation. Korean J Pediatr 2018; 61(7):205-9.
12. Shapiro R, Sarwal MM. Pediatric kidney transplantation. Pediatr Clin North Am 2010;57:393-400
13. St Nicholas Hospital, Lagos. 2021. https://en.wikipedia.org/wiki/St._Nicholas_Hospital,_Lagos. (accessed 1 December 2020).
14. Akinsola W. Only 8 renal transplantation centres exist in Nigeria- Nephrologist. 2020. https://nnn.com.ng/only-8-renal-transplantation-centres-exist-in-nigeria-nephrologist/.(accessed 10 January 2020).
15. North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2010 Annual Transplant Report. https://web.emmes.com/study/ped/annlrept/2010_Report.pdf. Accessed April 3, 2013. (accessed 10 January 2020).
16. Bamgboye EL. Barriers to a functional renal transplant program in developing countries. Ethn Dis 2009; 19(1 Suppl 1): 56–9.
17. Raji YR, Ajayi SO, Gbadegesin BA, Bello TO, Salako BL. Challenges facing the growth of kidney transplantation programs in Nigeria: Perceptions and knowledge of the nephrologists and other health care providers. Indian J Transplant 2017;11:184-93.
18. Okafor UH. Transplant tourism among kidney transplant patients in Eastern Nigeria. BMC Nephrology 2017; 18:215
19. World Medical Association WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. 59th WMA General Assembly, Seoul, Korea, 2008. www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. (accessed 10 January 2020).
20. National Health Acts. 2014 https://nigeriahealthwatch.com/wp-content/uploads/bsk-pdf-manager/2018/07/01_-Official-Gazette-of-the-National-Health-Act-FGN.pdf (accessed 11 January 2020).
21. Thiessen C, Kim YA, Formica R, Bia M, Kulkami S. Written informed consent for living kidney donors: practices and compliance with CMS and OPTN requirements. Am J Transplant 2013;13:2713–21.
22. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017;101: 1783–92.
23. BTS/RA living donor kidney transplantation guidelines. 2018. Guidelines for living donor kidney transplantation. Fourth edition. https://bts.org.uk/wp-content/uploads/2018/01/BTS_LDKT_UK_Guidelines_2018.pdf. (accessed 10 January 2020).
24. Ibadin OM, Ofovwe EG. Chronic renal failure in children of Benin, Nigeria. Saudi J Kidney Dis Transpl 2004; 15: 79-83.
25. Anochie i, Eke F. Chronic renal failure in children: a report from Port-Harcourt, Nigeria (1985-2000). Pediatr nephrol 2003, 18(7):692–5.
26. Olowu WA, Adefehinti O, Aladekomo TA. Epidemiology and Clinicopathologic Outcome of Pediatric Chronic Kidney Disease in Nigeria, a Single Cenetr Study. Arab J Nephrol Transplant 2013; 6 (2), 105-13.
27. Olowu W. Childhood-onset systemic lupus erythematosus. J Natl Med Assoc 2007;99:777-84.
28. Broghammer JA. Urethral Strictures in Males. https://emedicine.medscape.com/article/450903-overview. (accessed 10 January 2020).
29. McDonald RA. Immunosuppression in renal transplantation in children. 2020. https://www.uptodate.com/contents/kidney-transplantation-in-children-immunosuppression. (accessed 10 March 2020).
30. Dharnidharka VR, Stablein DM, Harmon WE. Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS. Am J Transplant 2004 Mar;4(3):384-9.
31. Huang E, Jordan SC. HLA desensitization in kidney transplantation. 2019. https://www.uptodate.com/contents/hla-desensitization-in-kidney-transplantation. (accessed 15 November 2019).
32. El Hennawy HM, Hashemy AA, Harbi NA, Habhab WT, Fahmy AE. A Single-Center 4-Year Experience with 47 Pediatric Renal Transplants: Evolving Trends. Saudi J Kidney Dis Transpl 2018;29(6):1303-1310
33. The 2014 Annual Report of the North American Renal Transplant Cooperative Study. 2014.https://www.web. emmes.com/study/ped/annlrept/annualrept2014.pdf. (accessed10 January 2020).
34. Shilbayeh S, Hazza I. Pediatric renal transplantation in the Jordanian population: The clinical outcome measures during long-term follow-up period. Pediatr Neonatol 2012;53:24-33.
35. Seeman T. Hypertension after renal transplantation. Pediatr Nephrol 2009; 24(5):959–72.10.1007/s00467-007-0627-7
36. Basiratnia M, Esteghamati M, Ajami GH, Amoozgar H, Cheriki C, Soltani M, et al. Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study. Pediatr Nephrol 2011; 26(3):449–57.
37. Dobrowolski LC, van Huis M, van der Lee JH, Peters Sengers H, Lilien MR, Cransberg K, et al. Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands. Nephrol Dial Transplant 2016; 31(11):1947–56.
38. Charmaya O, Moudgil A. Hypertension in the Pediatric Kidney Transplant Recipient. Front Pediatr 2017;5:86
39. Vlahakos DV , Marathias KP , Agroyannis B. Madias NE. Posttransplant erythrocytosis. Kidney Int 2003; 63(4):1187-94.
40. Vishnu P, Moreno Vanegas Y, Wadei HM, et al Post-transplant erythrocytosis refractory to ACE inhibitors and angiotensin receptor blockers. Case Reports 2018;2018:bcr-2018-224622
41. McEnery PT, Nathan J, Bates SR, Daniels SR. Convulsions in children undergoing renal transplantation. J Pediatr 1989;115(4):532–6.
42. Lina P, Tiana X , Wang X. Seizures after transplantation. Eur J Epilep 2018:61:177-185.
43. Drake K, Nehus E, Goebel J. Hyponatremia, hypo-osmolality, and seizures in children early post-kidney transplant. Pediatr Transpl 2015;19(7):698–703
44. Vernon HJ, Sperati CJ, King JD, Poretti A, Miller NR, Sloan JL, et al. A detailed analysis of methylmalonic acid kinetics during hemodialysis and after combined liver/kidney transplantation in a patient with mut (0) methylmalonic acidemia. J Inherit Metab Dis 2014;37(6):899–907.
45. Khalil MAM, Khalil MAU, Khan TFT, Tan J Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians. J Transplant 2018, Article ID 9429265, 22 pages
46. Emiroğlu R, Moray G, Sevmiş S, Sözen MH, Bilgin N, Haberal M. Long-term results of pediatric renal transplantation at one center in Turkey. Transplant Proc 2005;37:675-8.
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