engleski

Therapy with kidney transplantation in children in Croatia

Introduction: Almost all children with terminal renal failure (TRF) are candidates for kidney transplantation (KTx). Croatia has total inhabitans of 4, 436 Million and children up to 18 years 900.864. The only specialized Pediatric Dialysis Unit in University Hospital Centre Zagreb includes predialysis follow up, chronic dialysis and follow up prior and after KTx. Material and Methods: We retrospectively reviewed data on 153 pts aged 3 weeks -18 years, treated with renal replacement therapy (RRT) caused by TRF. Out of them in 98 (64%) was performed therapy with kidney transplant. Period of follow-up was since 1985 till the end of 2009. Included were children who start dialysis treatment ( hemodialysis or peritoneal dialysis) or preemptive KTx younger than 18 years and dialysed patients who received KTx up to 21 yr. Results and Discussion: During 25 ys in 98 children KTx was performed, what is 64% of all children on RRT. Out of them 71% were males, Preemptive KTx underwent 9 pts. From living related donors were 29 % and 71% from deceased.With functioning graft died 2, and graft loss was in 4 during the first yr post transplant and in 24 from 2-12 ys after KTx. In 7 pts of these the second KTx was performed. KTx were performed in 82% at KTx Centre at Urology Department located at the same hospital, others in centers in Rijeka or abroad. During 25 years various immunosupression protocols have been used, but basically they include protocols for: 1. low risk patients, 2. high risk patients, and 3. children in whom is expected delayed graft function. Croatia joined Eurotransplant (ET) as regular member in August 15th 2007. Until that 84 children were transplanted. Average waiting time on dialysis prior joining to ET was 4.5 yrs or on average 3-4 pts were transplanted/yr. After the waiting time is 2, 5 ys and there were transplanted 6 pts/yr. Conclusions: In Croatia organized KTx program in TRF was established before 25 ys. Last 2, 5 years Croatia is the regular member of ET. Benefits of these are: more transplantations per year, and resolving long-waiting pts. Problems are longer cold ischemia time, and higher miss match. Close collaboration with parents and pts is necessary for longterm good outcome. Special attention is needed in transplanted children when they reach adolescent age due to nonadherence to the therapy.

children; kidney transplantation

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