The choice between deceased and living donor kidney transplantation in children and adolescents: a multicentric cross-sectional study.

INTRODUCTION: The aim of our study was to evaluate the factors influencing the choice between a deceased donor (DD) and living donor kidney transplantation (LD KT) for children and adolescents with chronic kidney disease (CKD) from the perspective of parents and physicians. METHODS: Patients with CKD stages 4 and 5 at the University Hospitals of Ghent, Leuven and Antwerp were included. Between February 2019 and March 2020, the corresponding questionnaires were distributed among parents and physicians in order to evaluate the potential differences between the medical recommendation and parental choice. RESULTS: Twenty-eight patients (median age 11 yr, range 2-19 yr), 10 girls and 18 boys were included. Three patients had undergone kidney transplantation in the past. Parents of 13 children opted for DD and 13 LD, and in two cases, there was no preference. Physicians recommended DD in 14 cases and LD in 14 cases. Parental choice corresponded with physician's recommendation in 22 cases. Parental reasons for choosing DD were medical (n = 7), socio-economic (n = 1), combination of both (n = 1) or no reason (n = 4). Pediatric nephrologists advised against LD for medical (n = 6) or socio-economic (n = 6) reasons or a combination of both (n = 2). CONCLUSION: In our cohort, the treating physicians regarded the family's socio-economic factors more important for not actively promoting LD than the parents. A better understanding and communication regarding perceived socio-economic hurdles between caretakers and families might contribute to a higher incidence of living kidney donation in Belgium.

Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience.

PURPOSE: Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. MATERIALS AND METHODS: A total of 18 children 9 to 17 years old were studied. Mean ± SD followup was 28.8 ± 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). RESULTS: Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean ± SD number of incontinence episodes weekly improved significantly from 23.2 ± 12.4 to 1.3 ± 2.63 (p <0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean ± SD daily frequency of catheterization from 5.2 ± 1.6 to 2.0 ± 1.9 (p <0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. CONCLUSIONS: Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.