Challenges in pediatric renal transplantation

Abstract

Transplantation in children is the best option to treat renal failure. Over the last 25 years the improvements in therapy have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Tolerance of the graft and minimization of side effects are the challenges for improving the outcome of children with a grafted kidney. Notwithstanding the difficulties in settling in children large multicenter trials to derive statistically useful data, many important contributions in the last years brought important modifications in the immunosuppressive therapy, including minimization protocols of steroids and calcineurin inhibitors and new induction drugs. New methods for diagnosis of anti HLA antibodies and some new protocols to improve both chance and outcome of transplantation in immunized subjects represent area of ongoing research of extreme interest for children.

Keywords: Kidney transplantation; Children; Immunosuppressive therapy; Acute humoral rejection; Desensitization

Core tip: Several novelties in the immunosuppressive treatment regimens in kidney transplantation in children are becoming available, with the aim of reducing the long terms side effects, particularly growth retardation, infections and malignancies, as well as improving the long term survival of the graft through a better treatment of chronic rejection. Moreover new induction drugs and specific protocols addressed to sensitized subjects may widen the possibility to receive a graft even for highly immunized children. These innovative aspects of therapy in kidney transplantation in children are reviewed.