Is Preoperative Preparation Time a Barrier to Small Children Being Ready for Kidney Transplantation?

BACKGROUND: Small children are less frequently transplanted when compared with older. The objective of the present study was to compare the preparation time for transplantation in children of different weights and to identify factors associated with a delay in the workup of small children. METHODS: We report on a retrospective cohort comprising all children referred for renal transplantation (RTx) workup between 2009 and 2017. The main outcome was transplantation workup time, defined as the time elapsed between the first consultation and when the child became ready for the surgery. RESULTS: A total of 389 children (63.5% males) were selected, with a median weight of 18 kg (interquartile range, 11-32). Patients were categorized into 2 groups: group A (study group): ≤15 kg (n = 165) and group B (control group): >15 kg (n = 224). The probability of being ready for RTx was comparable between groups A and B. The cumulative incidence rate difference between groups is -0.05 (95% confidence interval, -0.03 to 0.02). The median time for RTx workup was 5.4 (2.4-9.4) in group A and 4.3 (2.2-9.0) months in group B (P = 0.451). Moreover, the presence of urinary tract malformation was associated with the need for longer transplantation workup time (P < 0.001). CONCLUSIONS: In children >7 kg, the workup time for transplantation is not related to body weight. In a specialized center, children weighing 7-15 kg became ready within the same timeframe as children weighing >15 kg, despite the smaller children had greater difficulty being nourished, dialyzed, and a greater need for surgical correction of the urinary tract pretransplant.

Avaliaçäo pondero-estatural de crianças e de adolescêntes com insuficiência renal crônica. Comparaçäo do período pré e pós-dialítico / Valuation ponder-estrutural of children and adolescents with chronic renal failure. Comparison of the period daily pay and afther-dialitic

Com o objetivo de avaliar o desenvolvimento pondero-estatural de crianças e adolescêntes com IRC, estudou-se o período compreendido entre os doze meses anteriores ao início da diálise(INICIO) e o período dialítico (DIA), por meio de dados clínicos e laboratoriais, quantificaçäo da ingestäo alimentar e avaliaçäo socioeconômica familiar. Verificou-se perda ponderal significativa em 3/13 pacientes, durante o período (PRE) e (INICIO), com recuperaçäo posterior em dois casos, e em 2/13 pacientes na fase (DIA), ocorreram dois casos de desnutriçäo aguda, um na fase PRE e outro na fase DIA, e 1 caso desnutriuçäo crônica, no período início. Em relaçäo à estatura, demonstro-se retardo de crescimento nos três períodos estudados. Dificuldades na provisäo de oferta nutricional equilibrada, o alto custo do trtatamento medicamentoso e a falta de uma política social de apoio ao doente renal crônico pediátrrico, constituíram-se em graves empecilhos ao manejo ótimo dessa síndrome clínica, contribuindo sinergicamente para o déficit de ganho pondero-estatural nesse grupo de crianças.(au)