Barbara M. Korsch

Kidney transplantation in children: Psychosocial follow-up study on child and family*

In 35 children treated for end-stage kidney disease with hemodialysis and transplantation, the psychosocial attributes of child and family were studied for their impact on long-term rehabilitation. Data were processed by a computerized system. The childrens personalities and family function, although severely stressed during acute treatment, usually had returned to preillness equilibrium within a year and were comparable to a control group of other chronically ill children. Fear of rejection of the kidney and damaged self-esteem were prominent. Personality tests confirmed clinical diagnoses concerning psychosocial pathology and occasionally preceded such diagnosis. Personality testing prior to treatment of end-stage kidney disease may aid in predicting rehabilitation potential.

Renal homotransplantation in children

Twenty-three children, aged 2 to 17 years, received 24 renal homotransplants from both live related donors and cadaver donors. Twenty-two children and 19 kidneys are surviving 1 to 32 months after transplantation. The clinical course of renal transplantation in children is described.

Experiences with children and their families during extended hemodialysis and kidney transplantation.

Psychologic responses of patients, family, and hospital staff to hemodialysis and renal transplantation.

RENAL TRANSPLANTATION IN CHILDREN

During the past 7 years (Feb. 1967 - Feb. 1974) 96 children received 121 renal allografts from 87 cadaveric, 31 live related and 3 live unrelated donors. Seventy four of the 96 children (76%) are currently surviving with functioning allografts (58 first and 16 second), 12 have died (13%) and 10 are undergoing dialysis (11%) while awaiting a subsequent graft. The primary renal disease was end-stage in 32%, specific glomerulopathies (GN) in 28%, including 11 patients with membrano-proliferative GN; obstructive uropathy in 22%, including 2 patients with an ileal loop and 18% with miscellaneous diseases including 4 patients with cystinosis. Forty seven of the 121 allografts failed, 74% were immunologic failures. No evidence of recurrence of the original disease was present in any of the grafts lost. Medical complications including hepatic dysfunction, cytomegalovirus and unusual bacterial and fungal infections, hypertension, cataracts, orthopedic problems, growth retardation and psychosocial problems leading to noncompliance were frequently encountered. Systematic psychosocial followup documents that despite complications almost all patients who survive at least 1 year with a functioning allograft return to preillness level of adaptation.

Renal transplantation in young children

Abstract Thirty-one children, aged one and a half to twelve years, received thirty-six renal allografts from fourteen living related donors, one living unrelated donor, and twenty-one cadaver donors during a five year period of study. Twenty-five of the thirty-one children (81 per cent) are presently alive with functioning allografts (twenty first and five second transplants); five children (16 per cent) have died and one child (3 per cent) is undergoing repetitive hemodialysis while awaiting a subsequent graft. The medical and surgical complications and rehabilitative aspects of the treatment program are delineated in detail to emphasize the acceptability of young children as candidates for renal transplantation.

The Outlook for Adolescents with Chronic Renal Failure

While the technical problems involved in hemodialysis and renal transplantation in adolescents are in general similar to those seen in adults, the emotional and psychological problems-from the time of diagnosis through dialysis and transplantation-are much more difficult to manage. Prevention, support, and early intervention when crises occur are basic to comprehensive care.

Renal retransplantation in children

Evaluation of 75 cadaver donor retransplants revealed that the primary factor influencing allograft survival is patient responsiveness as reflected by sensitization with preformed cytotoxic antibodies. Actuarial allograft survival rates for nonpresensitized (less than 5%) and moderately presensitized (5 to 50%) recipients were significantly (P less than 0.01) better than those of highly presensitized (greater than 50%) recipients. Although HLA A&B antigen histocompatibility did not have a statistically significant effect on retransplant outcome, it appeared to influence allograft survival in the highly presensitized recipient. An approach to the management of children who lose an initial or subsequent allograft is indicated by these data.

Current Issues in Pediatric Renal Transplantation

Multitudinous medical, surgical, and psychosocial problems continue to plague the pediatric renal allograft recipient. Considerable investigative efforts are required to improve the lives of children who require such therapy. Some of the more significant problems are delineated.

Renal Transplantation in Children

The goal of a successful transplant has beep accomplished in more than three fourths of the children with end-stage kidney disease treated in a special program undertaken at Los Angeles Childrens Hospital some years ago. In general, rehabilitation (both physical and psychologic) and growth have been highly satisfactory, the latter especially when transplantation was carried out before puberty.

How do Nurses Expand Their Roles in Well Child Care

A noted team of researchers analyzes the extent to which pediatric nurses in extended roles include social, emotional, and behavioral issues in well child conferences with mothers.