PMID- 23605376
OWN - NLM
STAT- MEDLINE
DCOM- 20140219
LR  - 20211021
IS  - 1432-198X (Electronic)
IS  - 0931-041X (Linking)
VI  - 28
IP  - 8
DP  - 2013 Aug
TI  - Nephrectomy for the failed renal allograft in children: predictors and outcomes.
PG  - 1299-305
LID - 10.1007/s00467-013-2477-9 [doi]
AB  - BACKGROUND: There are no guidelines for the removal of a failed renal allograft, 
      and its impact on subsequent dialysis and retransplantation has not yet been 
      described. METHODS: We performed a 10-year review of allograft failure to study 
      the factors that determined an outcome of transplant nephrectomy and choice of 
      subsequent renal replacement therapy in children with or without nephrectomy. 
      RESULTS: A total of 34 children developed graft failure over the 10-year study 
      period, of whom 18 (53 %) required transplant nephrectomy. The median graft 
      survival was 1.1 (range 0.2-10.6) versus 7.5 (1.5-15.0) years in the nephrectomy 
      and non-nephrectomy groups, respectively (p = 0.011). Children with graft failure 
      within 1 year of transplantation were four-fold more likely to require transplant 
      nephrectomy than those with graft failure after 1 year (p = 0.04). Renal biopsy 
      performed at </= 8 weeks prior to graft loss showed Banff grade II acute rejection 
      in 13 of the 18 children who required subsequent nephrectomy versus three of the 
      13 children who did not need nephrectomy (p = 0.01). Inflammation (fever, graft 
      tenderness and raised C-reactive protein (CRP) in the 2 weeks preceding graft 
      failure) was seen in 66 % of nephrectomized children, but not in any in the 
      non-nephrectomy group (p = 0.0003 for CRP between groups). Banff II rejection, an 
      inflammatory response and the time post-transplantation significantly and 
      independently predicted the outcome of nephrectomy (p = 0.008, R (2) = 67 %). 
      Human leukocyte antigen (HLA) antibody levels after graft failure were higher in 
      the nephrectomy group (p = 0.0003), but there was no difference between groups in 
      terms of the presence or class of donor-specific antibodies. Of the children with 
      graft failure, 82 % required dialysis (61 % hemodialysis) and 35 % have to date 
      been successfully retransplanted. CONCLUSIONS: Children with Banff II rejection, 
      an inflammatory response and early graft loss are more likely to require 
      transplant nephrectomy. Nephrectomy may be associated with higher circulating HLA 
      antibody levels.
FAU - Minson, Susan
AU  - Minson S
AD  - Renal Unit, Great Ormond Street Hospital for Children, Great Ormond Street, 
      London, WC1N 3JH, UK.
FAU - Munoz, Marina
AU  - Munoz M
FAU - Vergara, Ines
AU  - Vergara I
FAU - Mraz, Martin
AU  - Mraz M
FAU - Vaughan, Robert
AU  - Vaughan R
FAU - Rees, Lesley
AU  - Rees L
FAU - Olsburgh, Jonathon
AU  - Olsburgh J
FAU - Calder, Francis
AU  - Calder F
FAU - Shroff, Rukshana
AU  - Shroff R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20130419
PL  - Germany
TA  - Pediatr Nephrol
JT  - Pediatric nephrology (Berlin, Germany)
JID - 8708728
RN  - 0 (Biomarkers)
RN  - 0 (HLA Antigens)
RN  - 0 (Inflammation Mediators)
RN  - 0 (Isoantibodies)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Age Factors
MH  - Biomarkers/blood
MH  - Biopsy
MH  - C-Reactive Protein/metabolism
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Graft Rejection/blood/immunology/pathology/surgery/*therapy
MH  - *Graft Survival
MH  - HLA Antigens/blood/immunology
MH  - Humans
MH  - Infant
MH  - Inflammation Mediators/blood
MH  - Isoantibodies/blood
MH  - Kaplan-Meier Estimate
MH  - Kidney Transplantation/*adverse effects
MH  - Male
MH  - Multivariate Analysis
MH  - *Nephrectomy/adverse effects
MH  - *Renal Dialysis/adverse effects
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Up-Regulation
EDAT- 2013/04/23 06:00
MHDA- 2014/02/20 06:00
CRDT- 2013/04/23 06:00
PHST- 2013/01/03 00:00 [received]
PHST- 2013/03/21 00:00 [accepted]
PHST- 2013/03/09 00:00 [revised]
PHST- 2013/04/23 06:00 [entrez]
PHST- 2013/04/23 06:00 [pubmed]
PHST- 2014/02/20 06:00 [medline]
AID - 10.1007/s00467-013-2477-9 [doi]
PST - ppublish
SO  - Pediatr Nephrol. 2013 Aug;28(8):1299-305. doi: 10.1007/s00467-013-2477-9. Epub 
      2013 Apr 19.