Living donors, fewer infections and better medicine have led to a greatly increased chance of survival after a kidney transplant in children over the past sixty years. The quality of life of children who received a donor kidney has also improved. Radboudumc has specialized in kidney transplants for children for decades and does a lot of research into the best treatment.
In 1959, the first kidney transplant was performed on a child, and today around 1,300 children worldwide receive a new kidney each year. It has become a successful treatment when the kidneys stop working properly and there is severe kidney failure. Transplanted kidneys work better today than in the early days when only 42% of kidneys were still functioning after five years. Now 93% of patients still have a functioning donor kidney after five years. Their quality of life has also improved significantly.
The fact that it is doing so much better is due, among other things, to better medicines that suppress the immune system. If patients do not take their medication, the immune system attacks the new kidney, resulting in rejection. “Today we have much better medicine available than in the past. This is the main reason for the donor kidney’s improved survival,’ says Loes Oomen. She is a medical researcher at the Department of Urology in Radboudumc. She and colleagues conducted a large study of the development of kidney transplants in children.
This research, published in Frontiers in Pediatrics, shows that the type of donor has changed. Most children who receive a new kidney, especially in the Netherlands, receive it from a living donor. Often from a parent. ‘This has several advantages; the parents are often young and healthy, the operation can be planned in advance, and there is usually a good genetic match,’ says Oomen. ‘A good genetic match reduces the chance of rejection.’
Radboudumc specializes in kidney transplants for children
Radboudumc Amalia Children’s Hospital is one of the three Dutch centers where kidney transplants are performed in children. Since 1968, more than 400 children have received a new kidney here. The development is comparable to the development in the rest of the world. In the Netherlands, doctors at Radboudumc only perform kidney transplants on children under the age of three. In them, however, the donor kidney is placed in the abdominal cavity because there is not enough room in the pelvis.
Prevent gene transplantation
Are we where we need to be? Oomen: “We are happy with the development and big steps have also been taken in the interdisciplinary surgery. But we want to further improve the treatment of these patients. A big challenge is adherence to therapy: We notice that especially teenage children do not always taking their medicine.’ Rejection can result.A new transplant is an option, but research shows it’s better to prevent it: retransplantation generally produces worse outcomes for patients.
To prevent dialysis or not?
How do we find the most suitable donor and how do we determine the right time for a transplant? Are you waiting for the most suitable donor with a risk of dialysis or not? Oomen would like answers to these questions. ‘Our knowledge of a DNA match helps us with this. And we also know that the age of the donor has an influence.’
Research from Nijmegen has previously shown that the bladder in children with a new kidney does not always function correctly. There is also another challenge there. New developments, such as the use of artificial intelligence, the pooling of patient data (such as in the European context in the European Health Data Space) or the development of kidney organoids for drug research are interesting methods for further research. Watch a video by the Kidney Foundation about the development of kidney organoids at Radboudumc here.
About the publication in Frontiers in Pediatrics
This article appeared in Frontiers in Pediatrics: Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades – Loes Oomen, Charlotte Bootsma-Robroeks, Elisabeth Cornelissen, Liesbeth de Wall, Wout Feitz. DOI: 10.3389/fped.2022.856630.