Second cadaveric kidney transplantations in the pediatric population.

OBJECTIVE: To evaluate the functional outcomes and complications among a series of second in comparison to first kidney transplantations in pediatric patients. MATERIALS AND METHODS: We reviewed 163 consecutive kidney transplants in pediatric recipients performed from 1978 to present: 120 cases (69.3%) were first transplants (group A) and 43 (24.8%), second transplant (group B). We analyzed the incidences of delayed graft function (DGF), medical and surgical complications, as well as medium- and long-term graft survivals. RESULTS: We observed DGF among 51 group A patients (43%) versus 32.5% of group B. Ten patients suffered vascular complications in group A (8.3%) versus one in group B (2.3%) (P < .05). The 15-year graft survivals were 54.2% for group A and 45% for group B. The 15-year patient survivals were 84.9% in group A versus 93.6% in group B. CONCLUSIONS: Second kidney transplantations for children are a satisfactory option that achieves good functional results as well as acceptable graft and patient survivals.

[Measurement of health-related quality of life in children with chronic kidney disease using a specific test. Influence of treatment]. / Medida mediante un test específico de la calidad de vida relacionada con la salud en niños con enfermedad renal crónica. Influencia del tratamiento.

INTRODUCTION: Chronic kidney disease (CKD) affects the daily life of the child especially during the stage where their personal development takes place. Adult renal patients have a demonstrated worse health related quality of life (HRQL) mainly under hemodialysis (HD), however there are few published data about HRQL in children with CKD, most of them obtained after patient s childhood or with generic tests that do not discriminate changes in a specific disease. OBJECTIVE: To assess how our patients perceive their health by measuring the HRQL and its most affected domains. To determine how the different therapies affect the child with CKD and the agreement on the opinion between children and their parents. MATERIAL AND METHODS: We included 71 CKD children and their parents in a cross-sectional study (33 transplanted, 11 peritoneal dialysis [PD], 5 HD, 22 conservative treatment). We used a specific quality of life test for CKD children that we had previously developed (TECAVNER). If the child was younger than 9 years, only their parents completed the survey. RESULTS: children on HD refer a worse HRQL followed by those who underwent PD and those transplanted. The best HRQL was obtained in children with conservative treatment. Both parents and children agree that the domains more frequently affected are physical activity and school attendance especially those on HD. The way the adolescents 15 years and older perceived their health was similar to that of their parents. This was not the case in the younger group, 9 through 15 ears.

Desarrollo de un cuestionario en español de medida de calidad de la vida en pacientes pediátricos con enfermedad renal crónica / Design of a quality of life questionnaire in Spanish for children with chronic kidney disease

El tratamiento actual de la enfermedad renal crónica en la infancia debe incluir los aspectos sociales y psicológicos implicados en la calidad de vida del niño y de su familia. Nuestro objetivo ha sido desarrollar un instrumento de medida específico de la calidad de vida de los pacientes pediátricos con enfermedad renal crónica en español, ya que no existe actualmente ninguno validado para niños. Hemos desarrollado un cuestionario en español específico para enfermedad renal en niños basado en el test de calidad de vida para adultos con enfermedad renal (KDQOL-SFTM) y en el test de calidad de vida para niños con epilepsia (CAVE) adaptándolos a niños con enfermedad renal, al que denominamos TECAVNER (Test de Calidad de Vida en Niños con Enfermedad Renal). La fiabilidad de dicho cuestionario, determinada por el coeficiente alfa Cronbach, fue de 0,92. Las limitaciones del estudio consisten en que no se ha realizado validez de constructo ni test-retest. En conclusión, este trabajo constituye un primer intento para diseñar un cuestionario específico de calidad de vida relacionada con la salud en español para niños con enfermedad renal crónica (AU)

Treatment of chronic kidney disease in childhood must include assessment of social and psychological aspects involved in the perceived quality of life of the child and its family. Our objective has been to design a specific tool in Spanish for measuring quality of life in pediatric patients with chronic kidney disease, since there is not a validated test for children at the moment. Results: We designed a specific questionnaire for kidney disease in children based on the test of quality of life for adults with kidney disease (KDQOL-SFTM) and on the test of quality of life for children with epilepsy (CAVE)adapting them to children with kidney disease, denominating TECAVNER (Test of Quality of Life in Children with Kidney Disease). Reliability of this questionnaire determined by alfa Cronbach coefficient was 0,92. Limitations: questionnaire determined by Test-retest reliability and construct validity were not conducted. In conclusion, this is a first approach for design a specific health related quality of life test in Spanish for children with chronic kidney disease (AU)

Medida mediante un test específico de la calidad de vida relacionada con la salud en niños con enfermedad renal crónica. Influencia del tratamiento / Measurement of health related quality of life in children with chronic kidney disease using a specific test. Influence of treatment

Introducción: La enfermedad renal crónica (ERC) modifica la vida del paciente y afecta de manera especial a los niños en su etapa de desarrollo personal. En adultos se ha demostrado peor calidad de vida relacionada con la salud(CVRS), sobre todo en hemodiálisis (HD); sin embargo, hay muy pocos datos objetivos sobre CVRS en niños con ERC, la mayoría obtenidos una vez superada la infancia de estos enfermos o con cuestionarios genéricos que no permiten discriminar cambios en una enfermedad específica. Objetivos: Conocer cómo perciben nuestros pacientes su estado de salud midiendo la CVRS y sus áreas más afectadas. Determinar la influencia de los distintos tratamientos y la concordancia entre la opinión de los niños y de sus padres. Material y métodos: Estudio transversal en 71 niños(33 sometidos a trasplante, 11 en diálisis peritoneal, cinco en HD y 22 en tratamiento conservador) y en sus padres. Utilizamos un cuestionario específico desarrollado por nosotros para la medida de CVRS en niños con ERC. En los menores de 9 años sólo contestaron los padres. Resultados: Los niños en HD refieren una peor CVRS, seguidos de los pacientes en diálisis peritoneal (DP) y de los sometidos a trasplante (TX), y la mejor CVRS se obtiene en los pacientes sometidos a tratamiento conservador. Los aspectos que más se ven alterados son la actividad física y la asistencia escolar, sobre todo en HD, hecho en el que coinciden padres e hijos. La concordancia entre padres e hijos fue buena en los mayores de 15 años, existiendo discordancia en los niños de 9 a 15 años (AU)

Introduction: Chronic kidney disease (CKD) affects the daily life of the child especially during the stage where their personal development takes place. Adult renal patients have a demonstrated worse health related quality of life (HRQL)mainly under hemodialysis (HD), however there are few published data about HRQL in children with CKD, most of them obtained after patient´s childhood or with generic tests that do not discriminate changes in a specific disease. Objetive: To assess how our patients perceive their health by measuring the HRQL and its most affected domains. To determine how the different therapies affect the child with CKD and the agreement on the opinion between children and their parents. Material and methods: We included 71CKD children and their parents in a cross-sectional study ( 33transplanted, 11 peritoneal dialysis [PD], 5 HD, 22conservative treatment). We used a specific quality of life test for CKD children that we had previously developed(TECAVNER). If the child was younger than 9 years, only their parents completed the survey. Results: Children on HD refer a worse HRQL followed those who underwent PD and those transplanted. The best HRQL was obtained in children with conservative treatment. Both parents and children agree that the domains more frequently affected are physicalactivity and school attendance especially those on HD. The way the adolescents 15 years and older perceived their health was similar to that of their parents. This was not the case in the younger group, 9 through 15 years (AU)

[Design of a quality of life questionnaire in Spanish for children with chronic kidney disease]. / Desarrollo de un cuestionario en español de medida de calidad de la vida en pacientes pediátricos con enfermedad renal crónica.

UNLABELLED: Treatment of chronic kidney disease in childhood must include assessment of social and psychological aspects involved in the perceived quality of life of the child and its family. Our objective has been to design a specific tool in Spanish for measuring quality of life in pediatric patients with chronic kidney disease, since there is not a validated test for children at the moment. RESULTS: We designed a specific questionnaire for kidney disease in children based on the test of quality of life for adults with kidney disease (KDQOL-SFTM) and on the test of quality of life for children with epilepsy (CAVE) adapting them to children with kidney disease, denominating TECAVNER (Test of Quality of Life in Children with Kidney Disease). Reliability of this questionnaire determined be alfa Cronbach coefficient was 0,92. LIMITATIONS: Questionnaire determined by Test-retest reliability and construct validity were not conducted. In conclusion, this is a first approach for design a specific health related quality of life test in Spanish for children with chronic kidney disease.

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay]. / Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en hospital de corta estancia.

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en Hospital de Corta Estancia / Retroperitoneoscopic nephrectomy: our experience in sort hospital stay

Objetivos. Demostrar que la nefrectomía, a pesar de ser un procedimiento de cirugía mayor, requiere una estancia hospitalaria menor de 48 horas, siempre que se realice mediante abordaje retroperitoneal laparoscópico. Consecuentemente este procedimiento puede ser realizado en el Hospital de Corta Estancia. Material y métodos. Desde 1995 hemos tratado 40 pacientes mediante nefrectomía retroperitoneoscópica con un total de 46 nefrectomías. En 6 pacientes fueron bilaterales por insuficiencia renal terminal (IRT), y por lo tanto no están reflejadas en este estudio. La edad media fue de 4,8 años (rango entre 6 meses y 13 años), con relación al sexo: varones (n=16) y hembras (n=18). En cuanto al lado de la nefrectomía fue derecho en 20 e izquierdo en 14. Las patologías que indicaron nefrectomía(n=34) por anulación funcional del riñón fueron: hidronefrosis obstructiva (n=2); megauréter obstructivo (n=1); nefropatía por reflujo vesicoureteral (n=8); displasia renal multiquística (n=11); riñón multiquístico desaparecido (n=12). Resultados. En todos los casos la nefrectomía fue retroperitoneal pura. El tiempo de duración quirúrgico medio fue de 92 min (rango de 60- 240 min). Se reconvirtió en 1 caso (4,5%) por microperforación peritoneal (n=1). Destacamos la ausencia de complicaciones inherentes al procedimiento retroperitoneoscópico intraoperatorio y postoperatorio. Como complicaciones secundarias al procedimiento quirúrgico se presentaron dos relajaciones de pared en herida incisional y un seroma de puerto de entrada. El sangrado durante el acto operatorio fue inapreciable, menor de 20 cc. No se dejaron drenajes en el lecho operatorio. La estancia media ha sido reducida a 27 horas, no siendo contabilizados los 6 casos de IRT. En los 18 últimos casos, el alta hospitalaria fue dada en las primeras 24 horas postoperatorias. La analgesia establecida por protocolo ha sido infiltración de puertos con bupivacaína 1% y una dosis de paracetamol/ibuprofeno a las 12 horas de la intervención, repetida al alta hospitalaria. La incorporación a su vida cotidiana –domicilio y escuela– ha sido precoz en el 100% de los casos. Destacamos la ausencia de complicaciones secundarias al dolor (respiratorias) y a la inmovilización. Conclusiones. La nefrectomía retroperitoneoscópica es una indicación claramente establecida y de obligada realización en la edad pediátrica. Es el abordaje quirúrgico idóneo para realizar una nefrectomía por su fiabilidad, reproducibilidad y seguridad. La estancia media se ha reducido con respecto a la cirugía convencional pudiéndose realizar en Hospital de Corta Estancia (AU)

Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventionalsurgery. Consequently this procedure can be carry out in a short hospital stay (AU)

[Pediatric renal transplantation from young children donors (aged < or = 6 years). Complications and functional clinical course]. / Trasplante renal pediátrico con injertos de donantes infantiles de corta edad (< or = 6 años). Complicaciones y evolución funcional.

GOALS: To evaluate functional results and complications in a group of pediatric patients who received kidney transplants from donors aged 6 years or less. MATERIAL & METHODS: Thirty-four consecutive renal transplants were reviewed. Of 34 patients, 19 (55.8%) received kidneys from donors aged below 3 years (Group A) and 15 (44.2%) from donors aged 3-6 years (Group B). Long-term functional patient and graft survival results along with complications were compared in both groups. RESULTS: Seven patients in group A (36.7%) had vascular complications, in comparison to 3 in group B (20%, p<0.05). Kidneys preserved in Eurocollins (EC) solution had more vascular complications (35.3%) in comparison to University of Wisconsin (UW) solution kidneys (23.5%, p<0.05). Ten-year graft survival rate in group A was significantly lower in comparison to group B (35.5% vs 58.6%, p<0.05). In relation to preservation solution type used, 10-year graft survival rate was also significantly better in UW group (26.8% vs 63%, p<0.001). CONCLUSIONS: The exclusion of donors younger than 3 years and the utilization of optimal preservation solutions produces a decrease in figures of vascular complications and a significant improvement in graft survival rates.

Trasplante renal pediátrico con injertos de donantes infantiles de corta edad (= 6 años). Complicaciones y evolución funcional / Pediatric renal transplantation from young children donors (aged = 6 years). Complications and functional evolution

OBJETIVO: Evaluar el resultado funcional y la incidencia de complicaciones en una serie de trasplantes renales pediátricos utilizando injertos de donantes infantiles. MATERIAL Y MÉTODO: Se revisa una serie de 34 trasplantes renales en receptores pediátricos realizados de forma consecutiva. De ellos, en 19 casos (55,8 por ciento) el riñón procedía de donantes de edad inferior a 3 años (Grupo A). En 15 pacientes (44,2 por ciento), los donantes tuvieron una edad = 3-6 años (Grupo B). Analizamos comparativamente el funcionalismo inmediato, complicaciones médicas y quirúrgicas, supervivencia del injerto y del paciente a medio y largo plazo. RESULTADOS: Observamos disfunción inicial del injerto en 9 pacientes del grupo A (47,4 por ciento). En el grupo B la incidencia fue del 46,7 por ciento. En el grupo A, 7 pacientes sufrieron complicaciones vasculares (36,7 por ciento) frente a 3 en el grupo B (20 por ciento) (p<0,05). Se produjeron más complicaciones vasculares en los riñones preservados en solución EC (35,3 por ciento) frente a UW (23,5 por ciento) (p<0,05). En el grupo A la supervivencia actuarial de los injertos a 10 años fue significativamente menor frente al grupo B (35,5 por ciento-58,6 por ciento, p<0,05). En base al tipo utilizado de solución de preservación, EC ofreció valores de supervivencia actuarial del injerto a 1-5-10 años de 47 por ciento-26,8 por ciento-26,8 por ciento; UW incrementó estas cifras a 82,3 por ciento-63 por ciento-63 por ciento (p<0,001). CONCLUSIONES: La limitación de la edad mínima para aceptación de donantes en Programas de Trasplante Renal Pediátrico en 3 años y la utilización de soluciones de preservación óptimas, resulta en una disminución de las complicaciones vasculares y un aumento de la supervivencia del injerto a largo plazo (AU)

Immunoprophylaxis with Simulect (basiliximab) in pediatric kidney transplant recipients: results from routine clinical practice at 5 kidney transplant units.

BACKGROUND: Simulect (basiliximab) was introduced in Spain in February 1999, being the first anti-interleukin-2 receptor monoclonal antibody used in our country for the prevention of acute rejection in kidney transplantation. The objective of this study was to assess the efficacy and safety of Simulect (basiliximab) in routine clinical practice in pediatric Spanish kidney transplantation units. METHODS: In this prospective, observational study, we collected data related to demographics, parameters of efficacy, immunosuppressive therapy, and safety on kidney transplant patients treated with Simulect (basiliximab) using an on-line collection system. RESULTS: Fifty pediatric patients at 5 kidney transplant units with 12 months follow-up included recipient mean age of 10.00 years (DS 5.40). Twenty-nine (58.00%) were boys and 21 (42.00%) were girls. Cold ischemia time was 15 hours and 50 minutes (DS 9.70 h). No patient presented with a PRA >50%. For prophylactic immunosuppression, 85.70% of patients received triple therapy with CNI (cyclosporine 48.97% or tacrolimus 36.73%), MMF (87.76%) or AZA (12.24%), and steroids. Acute rejection incidence at 12 months was 22%, including 3 steroid-resistant episodes (6%). One patient lost the graft (2%), 7 adverse events (AE) were reported (1 mild, 4 moderate, and 1 severe AE), of which none were attributed to the study drug. CONCLUSIONS: Simulect (basiliximab) treatment of pediatric patients who underwent kidney transplantations performed in routine clinical practice showed good prophylaxis against acute rejection with excellent safety.

Paediatric experience with acetate-free biofiltration.

We describe our preliminary experience with five children who received acetate-free biofiltration, a modification of haemodiafiltration without buffer in the dialysate and simultaneous infusion of bicarbonate through a venous port. Adequacy of haemodialysis (HD) was achieved with 3 h treatments three times per week (mean Kt/v 1.35 +/- 0.29, mean protein catabolic rate (PCR) 1.4 +/- 0.3 mg/dl). During the session, pH increased from 7.4 pre HD to 7.5 post HD. The mean bicarbonate infused as a 0.166 M solution averaged 235 +/- 35 mEq/h. Hypertension did not occur. There were no cramps, hypotension or vomiting. Bicarbonate requirements correlated significantly with dialyser surface area and body weight (r = 0.76, P < 0.001).

[Pediatric kidney transplants and herpesvirus infections]. / Trasplante renal pediátrico e infecciones por virus del grupo herpes.

Twenty seven children were followed up prospectively after renal transplant for evidence of infection and illness due to cytomegalovirus (CMV), Epstein-Barr virus (EBV) and varicella zoster virus (VZV). Virus shedding and serological status were tested at transplant day, biweekly for two months, monthly for six months and trimestrialy thereafter. Determinations were done by complement fixation test. CMV isolation was established by microscopic examination of urinary cultures. Primary infections were objetivated in 27 cases (18 CMV, 1 EBV, 8 VZV) and reinfection in 3 (2 CMV, 1 VZV). Irreversible allograft rejection related to infection was disclosed in 2 patients (1 primary CMV infection, 1 VZV reinfection). Renal function impairment occurred only with CMV (6 primary and 1 secondary infections). One patient died with CMV over infection.