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  • Review Article
  • Published:

Long-term effects of paediatric kidney transplantation

Nature Reviews Nephrology volume 12, pages 301–311 (2016)Cite this article

Subjects

Key Points

  • Renal transplantation can be successfully performed in all age groups and outcomes have improved since the 1960s and 1970s

  • The diagnoses of end-stage renal disease (ESRD) in children differ from those observed in adults, and vary according to the study population and ethnicity

  • The majority of children with early diagnosis of chronic kidney disease and appropriate active therapy of ESRD grow and develop normally during childhood

  • Late diagnosis of ESRD, comorbidities, risk factors for impaired development, sepsis, hypertensive crises and reduced graft function have an impact on the development and quality of life of paediatric transplant recipients

  • Clinicians must be especially alert to growth, bone health, metabolic and cardiovascular complications, and malignancies in paediatric patients who have undergone renal transplantation

  • The transition of paediatric patients to adult clinics needs to be well organized; adolescents should only be transferred when they are sufficiently mature and able to independently manage their own health

Abstract

Renal transplantation in paediatric patients usually provides excellent short-term and medium-term results. Early diagnosis of chronic kidney disease and active therapy of end-stage renal disease before and after transplantation enables the majority of children to grow and develop normally. The adverse effects of immunosuppressive medication and reduced graft function might, however, hamper long-term outcomes in these patients and can lead to metabolic complications, cardiovascular disease, reduced bone health, and malignancies. The neurocognitive development and quality of life of paediatric transplant recipients largely depend on the primary diagnosis and on graft function. Poor adherence to immunosuppression is an important risk factor for graft loss in adolescents, and controlled transition to adult care is of utmost importance to ensure a continued normal life. In this Review, we discuss the outcomes and long-term effects of renal transplantation in paediatric recipients, including consequences on growth, development, bone, metabolic, and cardiovascular disorders. We discuss the key problems in the care of paediatric renal transplant recipients and the remaining challenges that should be the focus of future research.

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Figure 1: Etiology of end-stage renal disease in paediatric renal transplant recipients.
Figure 2: Effect of growth hormone therapy on height in paediatric patients with CKD, undergoing dialysis and after renal transplantation.

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Acknowledgements

The authors' work is supported by the Sigrid Juselius Foundation, the Paediatric Research Foundation, the Helsinki University Hospital Fund, and the Päivikki and Sakari Sohlberg Foundation.

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  1. Department of Paediatric Nephrology & Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbäckinkatu 11, PO BOX 281, Helsinki, 00290, FI, Finland

    Christer Holmberg & Hannu Jalanko

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Both authors researched the data for the article, provided a substantial contribution to discussions of the content, contributed equally to writing the article and to review and/or editing of the manuscript before submission.

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Holmberg, C., Jalanko, H. Long-term effects of paediatric kidney transplantation. Nat Rev Nephrol 12, 301–311 (2016). https://doi.org/10.1038/nrneph.2015.197

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