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Rheda RGG, Pereira AML, Pestana JM, Koch Nogueira PC. Time from kidney failure onset to transplantation and its impact on growth in pediatric patients. Pediatr Transplant 2023; 27:e14507. [PMID: 36919407 DOI: 10.1111/petr.14507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/01/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height. METHODS Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height. RESULTS A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05-1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49-0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53-0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53-0.75; p < .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001). CONCLUSION Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.
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Kifle F, Kifleyohanes T, Moore J, Teshome A, Biccard BM. Indications, Challenges, and Characteristics of Successful Implementation of Perioperative Registries in Low Resource Settings: A Systematic Review. World J Surg 2023; 47:1387-1396. [PMID: 36656359 PMCID: PMC10156757 DOI: 10.1007/s00268-023-06909-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/20/2023]
Abstract
Perioperative registries can be utilised to track outcomes, develop risk prediction models, and make evidence-based decisions and interventions. To better understand and support initiatives to establish clinical registries, this study aimed to assess the indications, challenges, and characteristics of successful perioperative registries in low-resource settings, where there is unmet surgical demand and patients have a mortality rate up to double that of high-income countries. We conducted a librarian-assisted literature search of international research databases of articles published between January 1969 and January 2021. Studies were filtered using predefined criteria and responses to two Mixed Method Appraisal Tool screening questions. A Direct Content Analysis Method was used to synthesis. e data for eligible studies based on predefined criteria. The search identified 2793 abstracts. After removing duplicates and excluding studies that did not meet eligibility criteria, twelve studies were included, conducted in South America (n = 4), Africa (n = 5), the Middle East (n = 2), and Asia (n = 1). The lack of context-specific data for determining and evaluating patient outcomes (n = 7) was the major indication for implementation. Organising local research teams and engaging stakeholders in the host country were associated with successful implementation. Inadequate funding for data collectors and monitoring data quality were identified as challenges (n = 4). The goal of a perioperative registry is to generate data to influence and support quality improvement, and national surgical policies. Efforts to establish perioperative registries in low- and middle-income countries should engage local teams and stakeholders and seek to overcome challenges in data collection and monitoring.
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Affiliation(s)
- Fitsum Kifle
- Division of Global Surgery, University of Cape Town (UCT), Cape Town, South Africa. .,College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia. .,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia.
| | - Tewodros Kifleyohanes
- College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia
| | - Jolene Moore
- College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.,School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia
| | | | - Bruce M Biccard
- Division of Global Surgery, University of Cape Town (UCT), Cape Town, South Africa.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia.,Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
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Tuma M, Silva Andrade N, Correia Aires R, Cristelli MP, Medina Pestana JO, Gallottini M. Oral findings in kidney transplant children and adolescents. Int J Paediatr Dent 2022; 32:894-902. [PMID: 35316550 DOI: 10.1111/ipd.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them. AIM To describe the oral conditions of post-renal transplant children and adolescents. DESIGN Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions. RESULTS A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug-induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience. CONCLUSION Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus.
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Affiliation(s)
- Marina Tuma
- DDS at the Special Care Dentistry Centre, School of Dentistry of the University of São Paulo, São Paulo (SP), Brazil
| | | | - Rosana Correia Aires
- DDS at the Special Care Dentistry Centre, School of Dentistry of the University of São Paulo, São Paulo (SP), Brazil
| | | | | | - Marina Gallottini
- DMD, PhD at the Special Care Dentistry Centre of the University of São Paulo, São Paulo (SP), Brazil
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Iyengar A, McCulloch MI. Paediatric kidney transplantation in under-resourced regions-a panoramic view. Pediatr Nephrol 2022; 37:745-755. [PMID: 33837847 PMCID: PMC8035609 DOI: 10.1007/s00467-021-05070-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.
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Affiliation(s)
- Arpana Iyengar
- Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.
| | - M I McCulloch
- Pediatric Nephrology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Feltran LDS, Genzani CP, Fonseca MJBM, da Silva EF, Baptista JC, de Carvalho MFC, Koch-Nogueira PC. Strategy to Enable and Accelerate Kidney Transplant in Small Children and Results of the First 130 Transplants in Children ≤15 kg in a Single Center. Transplantation 2020; 104:e236-e242. [PMID: 32732842 DOI: 10.1097/tp.0000000000003300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proper care of young children in need of kidney transplant (KT) requires many skilled professionals and an expensive hospital structure. Small children have lesser access to KT. METHODS We describe a strategy performed in Brazil to enable and accelerate KT in children ≤15 kg based on the establishment of one specialized transplant center, focused on small children, and cooperating with distant centers throughout the country. Actions on 3 fronts were implemented: (a) providing excellent medical assistance, (b) coordinating educational activities to disseminate expertise and establish a professional network, and (c) fostering research to promote scientific knowledge. We presented the number and outcomes of small children KT as a result of this strategy. RESULTS Three hundred forty-six pediatric KTs were performed in the specialized center from 2009 to 2017, being 130 in children ≤15 kg (38%, being 41 children ≤10 kg) and 216 in >15 kg (62%). Patient survival after 1 and 5 years of the transplant was 97% and 95% in the "small children" group, whereas, in the "heavier children" group, it was 99% and 96% (P = 0.923). Regarding graft survival, we observed in the "small children" group, 91% and 87%, whereas in the "heavier children" group, 94% and 87% (P = 0.873). These results are comparable to the literature data. Groups were similar in the incidence of reoperation, vascular thrombosis, posttransplant lymphoproliferative disease, and estimated glomerular filtration rate. CONCLUSIONS The strategy allowed an improvement in the number of KT in small children with excellent results. We believe this experience may be useful in other locations.
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Affiliation(s)
| | - Camila Penteado Genzani
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
| | | | - Erica Francisco da Silva
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
| | - José Carlos Baptista
- Vascular Surgery Department, Federal University of São Paulo/UNIFESP, São Paulo, Brazil
| | | | - Paulo Cesar Koch-Nogueira
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Federal University of São Paulo/UNIFESP, São Paulo, Brazil
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