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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 33 - Pediatric kidney transplantation

from Section 5 - Kidney

Summary

Careful selection of both donor and recipient is crucial in preventing donor complications and optimizing recipient outcomes. Hepatocellular carcinoma (HCC) patients usually have less portal hypertension and lower chemical Model for End-Stage Liver Disease (MELD) scores. Donor selection criteria vary slightly among different programs. Donor safety is the primary concern; therefore, the ideal graft is the one that leaves a donor a future liver remnant (FLR) above 35% and at the same time provides a graft with an adequate size with respect to the recipient. Despite donor safety being of paramount importance in living donor liver transplantation (LDLT), finite morbidity and mortality rates has been reported worldwide. Intraoperative hemodynamic studies are emerging in recent years as a tool to guide implantation technique and in low modulation. The severity of liver disease and recipient status along with severe portal hypertension also affects the risk of small-for-size syndrome (SFSS).

Further reading

CochatP, FargueS, MestralletG, et al. Disease recurrence in paediatric renal transplantation. Pediatr Nephrol 2009; 24: 2097–108.
FineRN, MartzK, StableinD. What have 20 years of data from the North American Pediatric Renal Transplant Cooperative Study taught us about growth following renal transplantation in infants, children, and adolescents with end-stage renal disease? Pediatr Nephrol 2010; 25: 739–46.
HarmonWE. Pediatric kidney transplantation. In AvnerED, HarmonWE, NiaudetP, YoshikawaN (eds). Pediatric Nephrology, 6th ed. Berlin: Springer, 2009.
HumarA, MatasAJ. Kidney transplantation. In Humar A, Matas AJ, Payne WD (eds). Atlas of Organ Transplantation. Berlin: Springer, 2009.
North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Annual Report (2008). Available at: https://web.emmes.com/study/ped/annlrept/annlrept.html (accessed March 1, 2010).
SheldonC, ShumyleA. Urological issues in pediatric renal transplantation. Curr Opin Urol 2008; 18: 413–8.