A. Aikawa

Outcomes of Pediatric ABO-Incompatible Kidney Transplantations Are Equivalent to ABO-Compatible Controls

BACKGROUND Due to the profound shortage of suitable deceased allografts, much effort has been made to investigate whether successful kidney transplantation (KT) is possible across the ABO blood group barrier even for pediatric recipients. METHODS We reviewed 52 consecutive ABO incompatible (ABOic) transplantation performed between September 1989 and March 2011. The mean age at transplantation was 10.6 ± 3.9 years (range, 4.4-19.7), with 35 boys and 17 girls. The donor-to-recipient ABO blood antigen incompatibility was as follows: A1/O (n = 17); B/O (n = 13); A1/B (n = 6); B/A1 (n = 1); A1B/B (n = 9); and A1B/A (n = 6). As a control group, data were collected from 271 pediatric ABO compatible (ABOc) living donor KT in the same period. RESULTS Overall acute rejection episodes (ARE) among the ABOic group were significantly higher than those of the ABOc group (44% vs 26%; P < .02). However, there was no difference in glomerular filtration rate (GFR) at 1 year after transplantation: 86 ± 31 mL/min for ABOic vs 99 ± 37 mL/min for ABOic, respectively. The 1-y, 5-y, and 10-year patient survival rates were 98%, 92%, and 92% in the ABOic group, respectively, and 99%, 98%, and 97% in the ABOc group, respectively (P = not significant [NS]). The overall 1-, 5-, 10-, and 15-year graft survival rates were 94%, 88%, 86%, and 86% in the ABOic group, respectively, and 95%, 92%, 88%, and 78% in the ABOc group, respectively. CONCLUSION ABOic KT provided long-term allograft and patient survivals equivalent to ABOc live donor transplantations.

Head circumference and development in young children after renal transplantation

Background:  Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation.

Adult height of three renal transplant patients after growth hormone therapy.

Three girls with normal growth hormone secretion had received renal transplantation when aged 2 to 6 years. They had had severely retarded growth (SD for height score was −7.4 to −3.7) at the time of transplantation. After renal transplantation, steroid was withdrawn and they were treated with recombinant human growth hormone; they subsequently reached adult heights of 145 to 156 cm. The SD for adult height score was −2.6 to −0.3. The adult height in two patients was over their target height, calculated using the mean of the parents’ height. This report shows the efficacy of steroid withdrawal and recombinant human growth hormone therapy in achieving adult height in these three girls after renal transplantation.

Clinical management and outcome of preemptive renal transplantation in children and adolescents

AbstractBackground. Recently, pediatric renal transplantation without prior maintenance dialysis (preemptive transplantation) has been performed. The details of perioperative management and outcomes of preemptive transplantation in Japanese pediatric recipients are unclear. Methods. Patients who received preemptive renal transplantation at the age of 18 or younger were studied retrospectively. Results. Eight patients with a mean age of 13 received preemptive transplantation from a parental donor. Their mean creatinine clearance was 8.4 ml/min per 1.73 m2 at the time of transplantation. Two patients required treatment for hyperkalemia before transplant. Initial immunosuppressive therapy was the conventional protocol in one recipient, cyclosporine in three, and tacrolimus in four. Three recipients developed clinical acute rejection between 6 days and 1 month posttransplant and were treated with high-dose methylprednisolone and deoxyspergualin. Noncompliance with immunosuppressive drug therapy was identified in one recipient and suspected in another. The follow-up period was between 6 months and 25 years after preemptive transplantation. All recipients were alive with functioning grafts at the last follow-up. The primary reason for selecting preemptive transplantation was the parents desire to avoid dialysis. Conclusion. Preemptive transplantation was safe and successful. Preemptive transplantation should be performed before dialysis is indicated to avoid hyperkalemia at the time of the operation. Patients who receive preemptive renal transplantation should be followed closely for noncompliance with immunosuppressive drug therapy.

Twenty‐four‐year‐old male patient with infantile onset of Schimke immuno‐osseous dysplasia

Osamu Motoyama, Masakazu Inoue, Akira Hasegawa, Ken Sakai, Takeshi Kawamura, Atushi Aikawa and Kikuo Iitaka Department of Pediatrics, Toho University Medical Center, Sakura Hospital, Chiba, Department of Pediatrics, Yamada Red Cross Hospital, Mie, Department of Nephrology, Toho University Medical Center, Omori Hospital, Tokyo, and Department of Pediatrics, Social Insurance Sagamino Hospital, Kanagawa, Japan

BK virus nephropathy in a patient with ABO-incompatible renal transplantation.

Abstract:  A 43‐year‐old woman with end‐stage renal disease originating from IgA nephropathy entered chronic haemodialysis therapy. She then received an ABO‐incompatible living related renal transplantation. Initial immunosuppression consisted of azathioprine, methylprednisolone and tacrolimus. At 155 days after transplantation, the azathioprine was changed to mycophenolate mofetil for continuous graft dysfunction. Furthermore, a total of three courses of anti‐rejection therapy was given. At 665 days after transplantation, diagnosis of BK‐virus nephropathy was made by immunohistochemical analysis and viral DNA assay. Therefore the immunosuppression therapy was reduced for graft dysfunction. All five renal biopsy specimens were examined retrospectively in order to determine when the BK virus nephropathy had developed. The expressions of SV40 large T antigens were detected from the third (117 days) to the fifth (665 days) biopsies, with increasing numbers of SV40 large T antigen positive cells. In addition, many cells contained inclusion bodies which were already present in the urinary sediment for 3 months post‐transplantation. Although it is difficult to make a diagnosis of early stage of BKVN, we have to consider with caution if urinary cells with inclusion body are seen. Awareness of BKVN at the earliest opportunity is important in order to avoid over‐immunosuppression.

Pharmacokinetic Profile of Twice- and Once-daily Tacrolimus in Pediatric Kidney Transplant Recipients

BACKGROUND The aim of this study was to assess the differences in pharmacokinetic (PK) profiles after the 1:1 ratio-based conversion from a twice-daily to a once-daily tacrolimus formulation (TD-TAC and OD-TAC, respectively) in pediatric recipients of kidney transplants. METHODS TD-TAC was initially administered to 29 pediatric patients who underwent kidney transplantations between April 2010 and September 2015 and were then subsequently switched to OD-TAC. The switch dose ratio was 1:1, and the 24-hour complete PK parameter assessment was performed before and after the regimen was changed from TD-TAC to OD-TAC. RESULTS The mean total daily dose at baseline was 5.5 ± 2.9 mg (0.18 ± 0.10 mg/kg body weight). Consecutive PK studies revealed no significant difference in the mean time to achieve maximum concentrations and the area under the concentration-time curve from 0 to 24 hours (AUC0-24) of both drug formulations. However, the mean trough concentration (Cmin) and the maximum concentration of OD-TAC were 22% and 6% lower and higher, respectively, than those of TD-TAC. Therefore, a better correlation was observed between the AUC0-24 and Cmin of OD-TAC than between those of TD-TAC. CONCLUSIONS After the change from TD-TAC to OD-TAC, the AUC0-24 values were equivalent despite a 22% reduction in Cmin. Cmin may therefore be an excellent predictor in the therapeutic drug monitoring of OD-TAC because of its superior correlation with AUC0-24.