Abstract:The number of children undergoing successful renal transplantations has been increasing steadily and as a result, general pediatricians are now more likely to encounter children with a kidney allograft in their practice. Although the medical care immediately after transplantation is mostly provided by transplant teams, more and more outpatient care will eventually be performed at the patient's local community. Medical care from general pediatricians is particularly important, especially for children who are residing far from transplant centers. As these children require prolong immunosuppressive therapies and are susceptible to various specific clinical problems, it is imperative for their primary care providers and pediatricians to be knowledgeable about their specific needs and be competent in providing care. This article highlights the roles and common practice related issues that pertain to general pediatricians in the care of pediatric renal allograft recipients.
Keith K. Lau,Lucy Giglia,Howard Chan等. 儿科医生对肾移植儿童的管理[J]. 中国当代儿科杂志, 2012, 14(2): 81-88.
Keith K. Lau,Lucy Giglia,Howard Chan et al. Management of children after renal transplantation: highlights for general pediatricians[J]. CJCP, 2012, 14(2): 81-88.
[3]Tejani A, Sullivan EK, Fine RN, Harmon W, Alexander S. Steady improvement in renal allograft survival among North American children: a five year appraisal by the North American Pediatric Renal Transplant Cooperative Study[J]. Kidney Int, 1995, 48(2): 551-553.
[4]Gulati A, Sarwal MM. Pediatric renal transplantation: an overview and update[J]. Curr Opin Pediatr, 2010, 22(2): 189-196.
[5]Webster A, Woodroffe RC, Taylor RS, Chapman JR, Craig JC. Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients[J]. Cochrane Database Syst Rev, 2005,(8):CD003961.
[6]Harmon W, Meyers K, Ingelfinger J, McDonald R, McIntosh M, Ho M, et al. Safety and efficacy of a calcineurin inhibitor avoidance regimen in pediatric renal transplantation[J]. J Am Soc Nephrol, 2006, 17(6): 1735-1745.
[7]Knight RJ, Villa M, Laskey R, Benavides C, Schoenberg L, Welsh M, et al. Risk factors for impaired wound healing in sirolimus-treated renal transplant recipients[J]. Clin Transplant, 2007, 21(4): 460-465.
[8]Zuber J, Anglicheau D, Elie C, Bererhi L, Timsit MO, Mamzer-Bruneel MF, et al. Sirolimus may reduce fertility in male renal transplant recipients[J]. Am J Transplant, 2008, 8(7): 1471-1479.
[10]Lau KK, Haddad MN, Berg GM, Perez RV, Butani L. Rapid steroid discontinuation for pediatric renal transplantation: a single center experience[J]. Pediatr Transplant, 2007, 11(5): 504-510.
[11]Lau KK, Berg GM, Schjoneman YG, Perez RV, Butani L. Extended experience with a steroid minimization immunosuppression protocol in pediatric renal transplant recipients[J]. Pediatr Transplant, 2010, 14(4): 488-495.
[12]Hocker B, John U, Plank C, Wuhl E, Weber LT, Misselwitz J, et al. Successful withdrawal of steroids in pediatric renal transplant recipients receiving cyclosporine A and mycophenolate mofetil treatment: results after four years[J]. Transplantation, 2004, 78(2): 228-234.
[13]Sarwal MM, Vidhun JR, Alexander SR, Satterwhite T, Millan M, Salvatierra O Jr. Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation[J]. Transplantation, 2003, 76(9): 1331-1339.
[14]Lau KK, Tancredi DJ, Perez RV, Butani L. Unusual pattern of dyslipidemia in children receiving steroid minimization immunosuppression after renal transplantation[J]. Clin J Am Soc Nephrol, 2010, 5(8): 1506-1512.
[15]Chan K, Taube D, Roufosse C, Cook T, Brookes P, Goodall D, et al. Kidney transplantation with minimized maintenance: alemtuzumab induction with tacrolimus monotherapy-an open label, randomized trial[J]. Transplantation, 2011, 92(7): 774-780.
[16]Peynaud D, Charpiat B, Vial T, Gallavardin M, Ducerf C. Tacrolimus severe overdosage after intake of masked grapefruit in orange marmalade[J]. Eur J Clin Pharmacol, 2007, 63(7): 721-722.
[17]Gaston RS. Maintenance immunosuppression in the renal transplant recipient: an overview[J]. Am J Kidney Dis, 2001, 38 (6 Suppl 6): S25-S35.
[18]Christians U, Jacobsen W, Benet LZ, Lampen A. Mechanisms of clinically relevant drug interactions associated with tacrolimus[J]. Clin Pharmacokinet, 2002, 41(11): 813-851.
[19]Snyder JJ, Israni AK, Peng Y, Zhang L, Simon TA, Kasiske BL. Rates of first infection following kidney transplant in the United States[J]. Kidney Int, 2009, 75(3): 317-326.
[20]Knoll G. Trends in kidney transplantation over the past decade[J]. Drugs, 2008, 68(Suppl 1): 3-10.
[21]Dantas SR, Kuboyama RH, Mazzali M, Moretti ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections[J]. J Hosp Infect, 2006, 63(2): 117-123.
[22]Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors[J]. Clin Transplant, 2006, 20(4): 401-409.
[23]Chavers BM, Solid CA, Gilbertson DT, Collins AJ. Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States[J]. J Am Soc Nephrol, 2007, 18(3): 952-959.
[24]Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of urinary infections in renal transplant recipients[J]. Transplant Proc, 2006, 38(8): 2414-2415.
[25]Lyerova L, Viklicky O, Nemcova D, Teplan V. The incidence of infectious diseases after renal transplantation: a single-centre experience[J]. Int J Antimicrob Agents, 2008, 31(Suppl 1): S58-S62.
[26]Silva A, Rodig N, Passerotti CP, Recabal P, Borer JG, Retik AB, et al. Risk factors for urinary tract infection after renal transplantation and its impact on graft function in children and young adults[J]. J Urol, 2010, 184(4): 1462-1467.
[27]Rivera-Sanchez R, Delgado-Ochoa D, FloresPaz RR, García-Jiménez EE, Espinosa-Hernández R, Bazan-Borges AA, et al. Prospective study of urinary tract infection surveillance after kidney transplantation[J]. BMC Infect Dis, 2010, 10: 245.
[28]John U, Everding AS, Kuwertz-Broking E, Bulla M, Muller-Wiefel DE, Misselwitz J, et al. High prevalence of febrile urinary tract infections after paediatric renal transplantation[J]. Nephrol Dial Transplant, 2006, 21(11): 3269-3274.
[29]Goto N, Oka S. Pneumocystis jirovecii pneumonia in kidney transplantation[J]. Transpl Infect Dis, 2011, 13(6): 551-558.
[30]Kranz B, Vester U, Wingen AM, Nadalin S, Paul A, Broelsch CE, et al. Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection[J]. Pediatr Transplant, 2008, 12(4): 474-478.
[31]De Keyzer K, Van Laecke S, Peeters P, Vanholder R. Human cytomegalovirus and kidney transplantation: a clinician's update[J]. Am J Kidney Dis, 2011, 58(1): 118-126.
[32]Kremers WK, Devarbhavi HC, Wiesner RH, Krom RA, Macon WR, Habermann TM. Post-transplant lymphoproliferative disorders following liver transplantation: incidence, risk factors and survival[J]. Am J Transplant, 2006, 6(5 Pt 1): 1017-1024.
[33]Rostaing L, Weclawiak H, Mengelle C, Kamar N. Viral infections after kidney transplantation[J]. Minerva Urol Nefrol, 2011, 63(1): 59-71.
[34]Ryu HJ, Hahn JS, Kim YS, Park K, Yang WI, Lee JD. Complete resolution of posttransplant lymphoproliferative disorder (diffuse large B-cell lymphoma) with reduction of immunosuppressive therapy[J]. Yonsei Med J, 2004, 45(3): 527-532.
[35]Pollara CP, Corbellini S, Chiappini S, Sandrini S, De Tomasi D, Bonfanti C, et al. Quantitative viral load measurement for BKV infection in renal transplant recipients as a predictive tool for BKVAN[J]. New Microbiol, 2011, 34(2): 165-171.
[36]Boeckh M. Prevention of VZV infection in immunosuppressed patients using antiviral agents[J]. Herpes, 2006, 13(3): 60-65.
[37]Weinstock DM, Boeckh M, Boulad F, Eagan JA, Fraser VJ, Henderson DK, et al. Postexposure prophylaxis against varicella-zoster virus infection among recipients of hematopoietic stem cell transplant: unresolved issues[J]. Infect Control Hosp Epidemiol, 2004, 25(7): 603-608.
[38]Peterson PK, Balfour HH Jr, Fryd DS, Ferguson RM, Simmons RL. Fever in renal transplant recipients: causes, prognostic significance and changing patterns at the University of Minnesota Hospital[J]. Am J Med, 1981, 71(3): 345-351.
[39]Nankivell BJ, Alexander SI. Rejection of the kidney allograft[J]. N Engl J Med, 2010, 363(15): 1451-1462.
[40]Nankivell BJ, Borrows RJ, Fung CL, O′Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy[J]. N Engl J Med 2003, 349(24): 2326-2333.
[41]Nankivell BJ, Kuypers DR. Diagnosis and prevention of chronic kidney allograft loss[J]. Lancet, 2011, 378(9800): 1428-1437.
[42]Danzinger-Isakov L, Kumar D. Guidelines for vaccination of solid organ transplant candidates and recipients[J]. Am J Transplant, 2009, 9 (Suppl 4): S258-S262.
[43]Hibberd PL, Rubin RH. Approach to immunization in the immunosuppressed host[J]. Infect Dis Clin North Am, 1990, 4(1): 123-142.
[44]Molrine DC, Hibberd PL. Vaccines for transplant recipients[J]. Infect Dis Clin North Am, 2001, 15(1): 273-305.
[45]Gangappa S, Kokko KE, Carlson LM, Gourley T, Newell KA, Pearson TC, et al. Immune responsiveness and protective immunity after transplantation[J]. Transpl Int, 2008, 21(4): 293-303.
[46]Diana A, Posfay-Barbe KM, Belli DC, Siegrist CA. Vaccine-induced immunity in children after orthotopic liver transplantation: a 12-yr review of the Swiss national reference center[J]. Pediatr Transplant, 2007, 11(1): 31-37.
[47]Posfay-Barbe KM, Siegrist CA. Immunization and transplantation-what is new and what is coming? [J]. Pediatr Transplant, 2009, 13: 404-410.
[48]Weinberg A, Horslen SP, Kaufman SS, Jesser R, Devoll-Zabrocki A, Fleckten BL, et al. Safety and immunogenicity of varicella-zoster virus vaccine in pediatric liver and intestine transplant recipients[J]. Am J Transplant, 2006, 6(3): 565-568.
[49]Kraft JN, Shaw JC. Varicella infection caused by Oka strain vaccine in a heart transplant recipient[J]. Arch Dermatol, 2006, 142(7): 943-945.
[50]Levitsky J, Te HS, Faust TW, Cohen SM. Varicella infection following varicella vaccination in a liver transplant recipient[J]. Am J Transplant, 2002, 2(9): 880-882.
[52]Pickering LK. Varicella-zoster infections[M]. 28 ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.
[53]Pergam SA, Limaye AP. Varicella zoster virus (VZV) in solid organ transplant recipients[J]. Am J Transplant, 2009, 9 (Suppl 4): S108-S115.
[54]Sciarretta S, Valenti V, Tocci G, Tocci G, Pontremoli R, Rosei EA, et al. Association of renal damage with cardiovascular diseases is independent of individual cardiovascular risk profile in hypertension: data from the Italy -Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease study[J]. J Hypertens, 2010, 28(2): 251-258.
[55]Levey AS, Beto JA, Coronado BE, Eknoyan G, Foley RN, Kasiske BL, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease[J]. Am J Kidney Dis, 1998, 32(5): 853-906.
[56]Querfeld U. The clinical significance of vascular calcification in young patients with end-stage renal disease[J]. Pediatr Nephrol, 2004, 19(5): 478-484.
[57]Chueh SC, Kahan BD. Dyslipidemia in renal transplant recipients treated with a sirolimus and cyclosporine-based immunosuppressive regimen: incidence, risk factors, progression, and prognosis[J]. Transplantation, 2003, 76(2): 375-382.
[58]Kasiske BL. Risk factors for accelerated atherosclerosis in renal transplant recipients[J]. Am J Med, 1988, 84(6): 985-992.
[59]Fellstrom B. Risk factors for and management of post-transplantation cardiovascular disease[J]. BioDrugs, 2001, 15(4): 261-278.
[60]Morales JM, Dominguez-Gil B. Cardiovascular risk profile with the new immunosuppressive combinations after renal transplantation[J]. J Hypertens, 2005, 23(9): 1609-1616.
[61]Morales JM. Cardiovascular risk profile in patients treated with sirolimus after renal transplantation[J]. Kidney Int Suppl, 2005, (93): S69-S73.
[62]Hanevold CD, Ho PL, Talley L, Mitsnefes MM. Obesity and renal transplant outcome: a report of the North American Pediatric Renal Transplant Cooperative Study[J]. Pediatrics, 2005, 115(2): 352-356.
[63]Silverstein DM. Risk factors for cardiovascular disease in pediatric renal transplant recipients[J]. Pediatr Transplant, 2004, 8(4): 386-393.
[64]Trappe R, Pohl H, Forberger A, Schindler R, Reinke P. Acute esophageal necrosis (black esophagus) in the renal transplant recipient: manifestation of primary cytomegalovirus infection[J]. Transpl Infect Dis, 2007, 9(1): 42-45.
[65]Fernandez-Cruz L, Targarona EM, Cugat E, Alcaraz A, Oppenheimer F. Acute pancreatitis after renal transplantation[J]. Br J Surg, 1989, 76(11): 1132-1135.
[66]Phatak UP, Seo-Mayer P, Jain D, Selbst M, Husain S, Pashankar DS. Mycophenolate mofetil-induced colitis in children[J]. J Clin Gastroenterol, 2009, 43(10): 967-969.
[67]Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression[J]. J Am Soc Nephrol, 2002, 13(1): 277-287.
[68]Fruhwirth M, Fischer H, Simma B, Ellemunter H. Elevated tacrolimus trough levels in association with mycophenolate mofetilinduced diarrhea: a case report[J]. Pediatr Transplant, 2001, 5(2): 132-134.
[69]Korus M, Stinson JN, Pool R, Williams A, Kagan S. Exploring the information needs of adolescents and their parents throughout the kidney transplant continuum[J]. Prog Transplant, 2011, 21(1): 53-60.
[70]Anthony SJ, Pollock Barziv S, Ng VL. Quality of life after pediatric solid organ transplantation[J]. Pediatr Clin North Am, 2010, 57(2): 559-574.
[71]Feinstein S, Keich R, Becker-Cohen R, Rinat C, Schwartz SB, Frishberg Y. Is noncompliance among adolescent renal transplant recipients inevitable?[J]. Pediatrics, 2005, 115(4): 969-973.
[72]Rianthavorn P, Ettenger RB, Malekzadeh M, Marik JL, Struber M. Noncompliance with immunosuppressive medications in pediatric and adolescent patients receiving solid-organ transplants[J]. Transplantation, 2004, 77(5): 778-782.
[73]Bollini P, Tibaldi G, Testa C, Munizza C. Understanding treatment adherence in affective disorders: a qualitative study[J]. J Psychiatr Ment Health Nurs, 2004, 11(6): 668-674.
[74]Wu YP, Aylward BS, Steele RG. Associations between internalizing symptoms and trajectories of medication adherence among pediatric renal and liver transplant recipients[J]. J Pediatr Psychol, 2010, 35(9): 1016-1027.
[75]Goldman KE. Dental management of patients with bone marrow and solid organ transplantation[J]. Dent Clin North Am, 2006, 50(4): 659-676.
[76]Poursanidou K, Garner P, Watson A. Hospital-school liaison: perspectives of health and education professionals supporting children with renal transplants[J]. J Child Health Care, 2008, 12(4): 253-267.