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Inicio Actas Urológicas Españolas (English Edition) Renal transplantation in pediatric recipients: Considerations and preoperative a...
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Vol. 47. Issue 6.
Pages 351-359 (July - August 2023)
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Vol. 47. Issue 6.
Pages 351-359 (July - August 2023)
Review article
Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies
Trasplante renal en receptor pediátrico: consideraciones y estrategias de evaluación preoperatoria
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B. Bañuelos Marcoa,1,
Corresponding author
banuelos.marco@gmail.com

Corresponding author.
, M.I. Dönmezb,1, T. Geppertc, T. Prudhommed, R. Campie, B. Mesnardf, V. Heviag, R. Boissierh, A. Pecoraroe, A. Territoi, on behalf of EAU - YAU Kidney Transplant, Pediatric Working Groups
a Departamento de Urología, Unidad de Trasplante Renal, Hospital Universitario Clínico San Carlos, Madrid, Spain
b Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
c Division of Pediatric Urology, Department of Urology, University Hospital Charité Berlin, Berlin, Germany
d Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
e Department of Urology, Florence University Hospital, Florence, Italy
f Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
g Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
h Department of Urology, La Conception University Hospital, Marseille, France
i Unidades de Oncología y Trasplante Renal, Fundación Puigvert, Florence, Italy
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Table 1. Etiology of ESRD (End stage renal disease) leading to transplantation in paediatric population. Outcomes from paediatric Kidney Transplantation in children and the role of timing in t paediatric Kidney Transplantation.
Table 2. Pre-transplant assessment of the pediatric recipient.
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Abstract
Introduction and objective

Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient.

Material and methods

A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines).

Results

Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed.

Conclusions

Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results.

Keywords:
Renal transplantation
Kidney
Preoperative
Assessment
Review
Children
Pediatric
Resumen
Introducción y objetivo

El trasplante renal en la población pediátrica difiere del trasplante en adultos en muchos aspectos. Esta revisión se centrará en los aspectos exclusivos del receptor pediátrico.

Material y métodos

Se realizó una revisión narrativa de la escasa literatura existente sobre la evaluación preoperatoria del trasplante renal en receptor pediátrico con un enfoque educativo. La búsqueda bibliográfica permitió identificar publicaciones en inglés entre enero de 2000 y octubre de 2022. Los estudios publicados se identificaron mediante búsquedas en las siguientes bases de datos electrónicas: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar y Research Gate. En aras de eficacia y fiabilidad, se utilizaron ensayos controlados aleatorizados, metaanálisis, revisiones sistemáticas de alta calidad y estudios grandes recientes bien diseñados, si estaban disponibles. Se realizaron búsquedas en internet para obtener información pertinente adicional (definiciones, políticas o directrices).

Resultados

El manejo de las anomalías urogenitales congénitas y la disfunción del tracto urinario inferior junto con la evaluación urológica pediátrica preoperatoria óptima para el trasplante renal en niños se ha abordado según la bibliografía disponible. Adicionalmente, se han mencionado consideraciones particulares relativas al trasplante preventivo y al trasplante de un riñón de tamaño adulto en un lactante o un niño pequeño.

Conclusiones

Los resultados del TR en niños han mejorado progresivamente en los últimos 15 años. El trasplante de donante vivo emparentado ofrece los mejores resultados, y el trasplante preventivo puede ayudar a evitar la diálisis. Las consideraciones quirúrgicas y médicas tanto en el tratamiento pretrasplante como postrasplante del receptor renal pediátrico son extremadamente importantes para obtener resultados mejores a corto y largo plazo.

Palabras clave:
Trasplante renal
Riñón
Preoperatorio
Evaluación
Revisión
Niños
Pediátrico

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