Successful cadaveric renal transplantation of patients highly sensitized to HLA Class I antigens.

The purpose of our investigation was to evaluate long-term graft survival and the role of histocompatibility in patients who were highly sensitized to human leukocyte antigen (HLA) Class I antigens and received a cadaveric renal transplant. Our multi-institutional study evaluated 7-yr graft outcomes and the histocompatibility requirements of 61 (6.1%) highly sensitized (anti-human globulin panel reactive antibody [AHG PRA], > or = 80%) cadaveric renal transplantation patients, transplanted between 1988 and 1997, among 999 consecutive cadaveric renal transplants.

Peritoneal penetration of amphotericin B lipid complex and fluconazole in a pediatric patient with fungal peritonitis.

Fungal peritonitis is a rare event in patients receiving peritoneal dialysis. This case report describes the blood and dialysate concentrations of fluconazole and amphotericin B following intravenous administration in a 5-month-old infant with Candida albicans peritonitis receiving continuous cyclic peritoneal dialysis. Fluconazole rapidly and efficiently penetrated the peritoneal fluid achieving concentrations that exceed the minimal inhibitory concentration (MIC) for most Candida species.

Neurodevelopmental outcome of children initiating peritoneal dialysis in early infancy.

A retrospective review of 34 infants who started long-term peritoneal dialysis at 1 year and who underwent a formal neurodevelopmental evaluation. In addition to dialysis, treatment of the patients included the use of calcium carbonate as the sole phosphate binder in all patients and supplemental nasogastric tube feeding in 27.

Posttransplant lymphoproliferative disorder in pediatric renal transplantation.

Of 84 renal transplants performed in our center since 1986, six recipients (7.1%) developed posttransplant lymphoproliferative disorder (PTLD). All received quadruple immunosuppression with Minnesota anti-lymphoblastic globulin or anti-thymocyte globulin, methylprednisolone, cyclosporine, and azathioprine or mycophenolate mofetil.

Recurrent bacteremia with enteric pathogens in recessive polycystic kidney disease.

Eight children with autosomal recessive polycystic kidney disease (ARPKD) and recurrent bacteremia with enteric pathogens are described. Typical clinical features of bacterial cholangitis were absent, although in five patients histological and/or microbiological data indicated that the bacteremic episodes originated in the biliary tree. Bacteremia with enteric pathogens or recurrent culture-negative febrile illness in a child with ARPKD should raise suspicion of cholangitis, even in the absence of typical clinical findings.

Capnocytophaga canimorsus peritonitis in a pediatric peritoneal dialysis patient.

Capnocytophaga canimorsus, a bacterium rarely encountered by clinicians, was responsible for the development of peritonitis in an 18-year-old white male on automated peritoneal dialysis following the puncture of his dialysis tubing by a domestic cat. Although more than 100 cases of septicemia caused by C. canimorsus have been reported, this is the first report of the organism causing peritonitis in a patient receiving peritoneal dialysis.

Longitudinal evaluation of transport kinetics in children receiving peritoneal dialysis.

Functional stability of the peritoneal membrane is necessary for maintenance of peritoneal dialysis (PD) as a therapeutic option. Few studies have investigated this issue in children. We evaluated the peritoneal membrane solute transport capacity longitudinally in 26 children (mean age 11.

Chronic dialysis in children and adolescents. The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study.

The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) summarizes data submitted from 130 centers on 2,208 patients in whom 2,787 independent courses of dialysis were performed between 1 January 1992 and 16 January 1996. Approximately two-thirds of the dialysis population were maintained on peritoneal dialysis (PD), with automated PD remaining the preferred modality. There were 964 episodes of peritonitis in 1,018 patient years, yielding an overall peritonitis rate of 1 episode every 13 patient months.

Center volume effects in pediatric renal transplantation. A report of the North American Pediatric Renal Transplant Cooperative Study.

An inverse relationship between mortality and center volume has been established for several surgical procedures. Given the distinctiveness of pediatric renal transplantation and the large variation in center volume, investigation for relationships between center volume and graft outcome was pursued using the North American Pediatric Transplant Cooperative Study database. Center volume groups were based on the total number of pediatric transplants reported from 1987 to 1995.

Adverse effect of peritonitis on peritoneal membrane function in children on dialysis.

The effect of peritonitis on peritoneal membrane solute transport characteristics was determined as part of a multicenter study in children on continuous ambulatory/cycling peritoneal dialysis. Ninety-three children each underwent a 4-h peritoneal equilibration test (PET) with 1,100 ml/m2 2.5% Dianeal for determination of mass transfer area coefficients (MTAC), dialysate to plasma ratios (D/P) for creatinine and urea at 0, 30, 60, 120, 180, and 240 min and dialysate glucose levels at 0, 30, 60, 120, 180, and 240 min for calculation of D/Do.

ABO-mismatched renal transplantation in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) and the Midwest Organ Bank (MOB).

Successful ABO-mismatched renal transplantation (RT) (blood group A2 donor to blood group B or O recipient) has occurred in adults in the setting of a low titer (< or =4) natural isoagglutinin (anti-A) level in the recipient of the mismatched organ. Similar experiences have rarely occurred in children. Between 1986-1996, 11 pediatric patients (6 male and 5 female) received 11 ABO-mismatched kidneys [7 cadaveric (CAD) and 4 living related donor (LRD)].

Renal transplantation in children with sickle cell disease: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).

Sickle cell disease is a rare cause of end-stage renal disease (ES-RD) in pediatrics accounting for only 0.5% and 0.2% of the patients registered in the dialysis and transplant arms of the NAPRTCS database, respectively.

Optimal care of the pediatric end-stage renal disease patient on dialysis.

This manuscript is an effort on behalf of the American Society of Pediatric Nephrology to provide recommendations designed to optimize the clinical care of pediatric patients with end-stage renal disease (ESRD). Although many of the recommendations are evidenced-based with the supporting data being derived from a variety of sources, including patient registries, others are opinion-based and derived from the combined clinical experience of the authors. In all cases, it is recommended that the decision to initiate dialysis should be made only after an assessment of a combination of biochemical and clinical characteristics.

The impact of the Dialysis Outcomes Quality Initiative Guidelines on the care of the pediatric end-stage renal disease patient.

The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Guidelines for hemodialysis and peritoneal dialysis adequacy, management of vascular access, and management of anemia are based primarily on evidence derived from the experience of adult dialysis patients. However, these Guidelines can also be used to improve the care of children with end-stage renal disease (ESRD). Some of the guidelines are directly applicable to pediatric dialysis patients, such as the preferential use of the internal jugular vein for placement of a central venous catheter for dialysis.

Long-term graft survival is improved in cadaveric renal retransplantation by flow cytometric crossmatching.

Background: Cadaveric renal retransplantation is associated with a higher risk of early graft failure than primary grafts. A large proportion of those graft losses is likely attributable to donor-directed HLA class I antibodies, detectable by flow cytometry cross-matching but not by conventional crossmatching techniques.

Methods: Long-term graft survival in a group of 106 recipients of consecutive cadaveric renal regrafts between 1990 and 1997, in whom a negative flow T-cell IgG crossmatch was required for transplantation, was compared with two other groups of cadaveric transplant recipients.

Transplantation rate of the blood group B waiting list is increased by using A2 and A2B kidneys.

Background: We have increased the transplantation rate for blood group B cadaveric waiting list candidates by transplanting them with A2 and A2B kidneys.

Methods: Since 1991, five of the seven renal transplant programs in our organ procurement organization service area have preferentially transplanted blood group A2 and A2B cadaveric kidneys to B blood group waiting list candidates with histories of low anti-A isoagglutinin titers.

Results: Between 1991 and 1997, these five centers performed transplantations on 71 patients from the B cadaveric waiting list.

Report of the American Society of Nephrology meetings.

Purpose: We summarize presentations on topics of interest to the pediatric urologist from the annual meeting of the American Society of Nephrology, November 1996.

Materials And Methods: We reviewed all abstracts submitted for presentation and subsequently published in abstract form. Only those abstracts containing information pertinent to the field of pediatric urology were summarized for this report.

Current advances in the therapy of chronic renal failure and end stage renal disease.

The improved outcomes recently experienced by children with chronic renal failure and end stage renal disease (ESRD) does not obviate the need to strive to better the quality of their physical, mental and emotional well-being. This article reviews some of the recent advances in the care of these children that are intended to achieve that goal. Dialysis topics include prescription, novel solutions, adequacy measures, management of anemia, and access.

Creatinine clearance following cimetidine for estimation of glomerular filtration rate.

Simultaneous inulin (C[in]) and creatinine clearance (C[Cr]) studies were performed on 53 pediatric renal patients using a cimetidine protocol. Since cimetidine blocks the tubular secretion of creatinine, it was hypothesized that C(Cr) measured following cimetidine would closely approximate the C(in). C(in) was compared with C(Cr) with the latter calculated from: (1) a 24-h urine collection, (2) plasma creatinine, height, and a proportionality constant, (3) the same plasma and urine specimens used for calculating C(in), and (4) from the plasma and urine specimens of the four 30-min clearance periods treated as a single 2-h clearance.

Influence of the Rh (D) blood group system on graft survival in renal transplantation.

Background: The Rh (D) blood group system has not traditionally been considered to be a clinically relevant histocompatibility barrier in transplantation since conflicting results of its clinical importance have been reported.

Methods: We analyzed 786 consecutive primary cadaveric renal transplants performed by transplant centers in our Organ Procurement Organization (OPO) between 1990 and 1997. We also analyzed United Network for Organ Sharing (UNOS) data on 26,469 kidney transplants done from April 1994 to June 1996.