Recent progress in im/m therapy and the post-Tx management have led to improving both graft and recipient survivalin pediatric kidney transplantation.
Recent progress 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: weeks post-
● 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:
o Etiology of graft dysfunction from weeks post- KTx include:
o Causes of graft dysfunction that develop acutely > 3 mo after Tx include:
o 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 expected via:
● CNI (Csp & Tac) nephrotoxicity can be seen acutely that is highly reversible after dose modification, or may be progressing to CKD that is usually irreversible.
● 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:
●Other 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.