Experience in pediatric renal transplantation. Guillermo Almenara Irigoyen national hospital- Lima, Peru. 2009 - 2021
Luciola Vasquez1, Carlos Molina1, Wilmer Bacilio1, Liliana Gonzáles1, Carlos Túllume1, Wilder Pinto1, Carlos Rondon1, Jose Rojas1, Jose Rivera1, Omar Mantilla1.
1Department of Organ Transplantation, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
Introduction: 91% of transplants in Peru are performed by the Social Security (EsSalud), the percentage of pediatric renal transplants ranges between 8-14.57% with respect to adults. In 2009, the Renal Transplant Service of the Organ Transplant Department of the Guillermo Almenara National Hospital began transplants in children (under 18 years of age), with 19 children benefiting in the first phase (2009-2013) and 50 children in the second phase (2014-2021). At the time of the report, 70 pediatric renal transplants were performed.
Objective: To describe the experience in pediatric renal transplantation in a Social Security Hospital.
Material and methods: Descriptive study of case series from January 2009 to December 2021.
Results: Total patients 69, Total renal transplants 70. Waiting time for cadaveric donor ranged: 7.7 (2-36months). Mean age: 11.8 (range: 5-17years). Sex: 63.16% female. 47.37% were from the province. The etiology was: Renal hypoplasia/dysplasia: 23.68%, Uropathy: 18.42%, Glomerulopathy: 28.94%, Non-affiliated: 10.42%, Others: 18.42% (Vasculitis, cryoglobulinemic syndrome, Alport syndrome, Autosomal recessive polycystic disease). Renal replacement therapy: hemodialysis: 81.58%, Pre dialysis: 5.26%. Lowest recipient weight: 12kg. Living related donor was 50%. Duplo transplant (Liver-Kidney): 1.43%. Renal graft: 24.3% was right, 1.42% en bloc. 20% had 2 and 2.86%: 3 arteries. Ureteral catheter was used in 51.4%. Bladder size in 21.4%. Immediate complications: vascular thrombosis 4.28%, graft dysfunction 1.42%. During the follow-up 12% of infection by Poliomavirus was reported, Diabetes de Novo: 4.34%, Recurrence of glomerulopathy (FSGS): 2.89%. All received induction, being Polyclonal(Thymoglobulin):32.86%; Maintenance therapy was: Tacrolimus, Mycophenolate Mofetil, Prednisone (the latter was withdrawn in some with renal malformations). Graft loss was: Vascular thrombosis: 2.89%, humoral rejection: 4.28% Chronic dysfunction: 5.71%. These losses were in the age group: 13-18 years. Overall survival: patient 98.5% and graft survival at 1, 5 and 10 years: 94.2%, 91.4% and 87.14% respectively. Patient loss was due to SARS Cov2.
Conclusion: 4.28% of graft losses occurred when transferred to adults. The low number of cadaveric donors increased with related living donor, with progressive use of laparoscopic nephrectomy. The experience of the Center allowed us to perform the first double transplant in a pediatric patient in the country.
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