Recent progress in im/m therapy and the post-Tx management have led to improving both graft and recipient survivalin pediatric kidney transplantation.
in im/m therapy and the post-Tx
management have led to improving both graft and ptn survival in pediatric KTx TR. However, long-term benefits have been limited by the sequelae related
to im/m, rejection, and recurrence of the original kidney disease. Several complications of KTx appear as graft dysfunction. Etiology of kidney graft dysfunction will
be varied with the timing after Tx.
The timing periods can be categorized as:
● Etiology of DGF (immediate renal failure that persists after Tx) include:
● Ptns with initial graft function who develop early kidney
insufficiency (i.e., Tx), the major causes of
graft dysfunction include:
● Kidney allograft dysfunction acutely observed > 3 mo after Tx
is mostly due to:
● Slowly progressing renal diseases that observed over years post- KTx most commonly induced by:
● Etiology of DGF that seen after KTx may include:
Etiology of graft dysfunction from weeks post- KTx include:
Causes of graft dysfunction that develop
acutely > 3 mo after Tx include:
Causes of allograft dysfunction that slowly
developed over years include:
● Ac Rj can be expected with an acute rise in the SCr level and can be confirmed histologically via allograft biopsy with the finding of AMR & ACR. So, SCr should be regularly monitored for the early diagnosis of Ac Rj.
● Despite that CAI (chronic
allograft injury) is the most commonly observed
etiology of graft loss after the 1st y after Tx, its underlying background still uncertain. The diagnosis can be
● CNI (Csp & Tac)
nephrotoxicity can be seen acutely that is highly
reversible after dose modification,
or may be progressing to CKD that is usually
● In pediatrics KTx,
recurrent native kidney diseases inducing allograft loss can be observed
in % of ptns.
Primary pediatric native kidney disease with a high
rate of recurrence rate in the kidney allograft may include:
complications that can be observed with pediatric kidney TR may include
HT, CVS disease, infection, cancer, DM, anemia, and surgical sequelae (e.g.,
urological and vascular sequelae). These can be contributing to allograft injury/dysfunction.