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Morning Report

Morning Report. February 17, 2010. Renal Transplants. Most frequent transplant 45% of all pediatric transplants 7% of renal transplants ≤ 17y 3 year survival exceeds survival on dialysis Age 0-14 Life expectancy increased by 30 years Age 15-19 Life expectancy increased by 25 years.

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Morning Report

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  1. Morning Report February 17, 2010

  2. Renal Transplants • Most frequent transplant • 45% of all pediatric transplants • 7% of renal transplants ≤ 17y • 3 year survival exceeds survival on dialysis • Age 0-14 • Life expectancy increased by 30 years • Age 15-19 • Life expectancy increased by 25 years

  3. Renal Transplants • Males • 59% • African American • 28% • Hispanic • 33% • Adolescents • 38.4%

  4. Lupus Medullary cystic disease

  5. Immunosuppression Prograf

  6. Immunosuppression Cellcept

  7. Immunosuppression

  8. Infectious complications • Most common cause of hospitalization during the first 24 months • Most common in first 6 months • Post-operative • Bacterial • UTI • Pulmonary Infections • Bactrim prophylaxis

  9. Infectious Complications • Viral • BK virus • Infects 90% of the population • 5% incidence nephritis • Important cause of allograft dysfunction • Active disease in kidney transplant patients are more common in patients who are initially BKV antibody-negative • Routine screening may be effective • Cidofovir

  10. Infectious Complications • Viral • CMV • Chronic rejection and late graft loss • 2 routes • Primary infection with negative recipient and positive donor • Positive recipient with reactivation or reinfection with a different strain • Symptoms • Asymptomatic • Fever, leukopenia, thrombocytopenia, pneumonitis, hepatitis, graft dysfunction • Incidence is higher in seronegative recipients • Ganciclovir and valganciclovir

  11. Infectious Complications • Viral • Varicella • Severe disease • Encephalitis, pneumonitis, hepatic dysfunction, death • If non-immune and exposed • PEP within 72 hours • If infected • IV acyclovir • Withdrawl of immunosuppressants • Prevention • Immunization prior to transplant • ? Immunization post transplant

  12. Infectious Complications • Viral • EBV • Most common in seronegative recipients • Reactivation is more likely to be asymptomatic • PTLD (Posttransplantlymphoproliferative disease) • Treatment • Reduce immunosuppression • Rituximab • Herpes • Severity depends on immunosuppression • Treatment • Acyclovir • Valacyclovir

  13. Outcomes • Rejection rate • <16% • Increased risk • Deceased donation • Race (African-American) • HLA-DR mismatches • Lack of induction therapy • >5 lifetime transfusions • Reversal of rejection • 53% Living donors • 47% Deceased donors

  14. Outcomes • Rejection • 41.3% chronic rejection • 7.4% acute rejection • 8.1% graft thrombosis • 7.9% disease recurrence • 6.3% nonadherence • Prevalent among adolescence

  15. Outcomes • Graft Survival • 1 year • LD – 92.2% • DD – 83.6% • 5 years • LD – 79.7% • DD – 65.1% • Patient Survival • >95% at 5 years • Primary causes of death • Infection • Cardiopulmonary disease • Cancer

  16. Long-Term Issues • Growth • Fail to reach normal genetic adult height • Baseline renal function • Corticosteroids • Treatment • Growth hormone • Hyperlipidemia • Hypertension • Obesity • New-onset diabetes

  17. Long-Term Issues • Malignancy • Lymphoproliferative • Immunosuppressants • Hirsutism • Gum hyperplasia • Nonadherence • Adverse effects • Need for peer acceptance

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