engleski

40TH ANNIVERSARY OF FIRST PEDIATRIC KIDNEY TRANSPLANTATION IN UNİVERSİTY HOSPİTAL CENTER ZAGREB

Introduction: Kidney transplantation (KT) is the optimal treatment for children with end-stage renal disease (ESRD). The first pediatric KT was introduced in 1964. in Pittsburgh, and the first pediatric KT in our Center was performed in 1982. to a 12 -year old boy with nephrotic syndrome. Methods: This is a retrospective, descriptive study. Results: In 40 years (1982-2022), 148 children have been followed at UHC Zagreb after KT. Out of this number, 82, 4% were performed in Croatia. There were more kidney transplants from deceased than from living donors (67.5% versus 32.4%), with 13.5% being preemptive. The majority of transplanted children (42.5%) had congenital anomalies of the kidneys and urinary tract as their primary disease, while other common causes of ESRD included glomerulonephritis (14, 8%), FSGS (12.2%), nephronophthisis (5.4%), congenital nephrotic syndrome (3.3%), polycystic kidney disease (3.3%), IgA nephropathy (2, 7%), and Alport syndrome (2.7%). Most of the patients (65.5%) were 6 - 15 years old, and 58% were male. Results: It was observed that one- year graft survival rates were 69% (1982 to 1990), 95% (1990- 2000), 92.3% (2000- 2010), 91.4% (2010- 2020), while five- year graft survival rates were 53.8% (1982 to 1990), 76, 2% (1990-2000), 81.5% (2000- 2010), 85.7% (2010- 2020). Ten- year patient survival rates were 85% (1982 to 2000), and 96.1% (2000-2020). Conclusion Outcomes after pediatric KT in Croatia have been markedly improved after the first decade, mainly due to greater surgical experience, improved immunosuppression and donor selection criteria. Patient survival and 5- year graft survival rates have dramatically improved after the first decade and continued to improve thereafter. One- year graft survival has remained the same since the 1990s. Despite the better outcomes following initial transplantation, many challenges such as newer immunosuppressive agents with optimal balance, improved surgical techniques and better antiviral prophylaxis, remain to be implemented in the years to come.

kidney transplant ; children ; end-stage renal disease

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