2004 NOV 8 - (NewsRx.com & NewsRx.net) -- Kidney transplantation is feasible in pediatric bone marrow transplant recipients.
'Improving survival rates following pediatric bone marrow transplantation (BMT) will likely result in greater numbers of children progressing to end-stage renal disease (ESRD) because of prior chemotherapy, irradiation, sepsis, and exposure to nephrotoxic agents,' scientists in the United States explained. 'Renal transplantation remains the treatment of choice for ESRD; however, the safety of renal transplantation in this unique population is not well established.'
S.E. Thomas and coauthors at the University of Michigan described their 'experience with living related renal transplantation in three pediatric patients with ESRD following prior BMT' - '[t]wo patients with neuroblastoma and ESRD because of BMT nephropathy, and one patient with Schimke immuno-osseous dysplasia and ESRD because of immune complex mediated glomerulonephritis and nephrotic syndrome.'
'Age at time of BMT ranged from 2 to 7 yr. All patients had stable bone marrow function prior to renal transplantation,' the investigators noted. 'Age at renal transplant ranged from 8 to 14 yr.'
'All three patients have been managed with conventional immunosuppression, as no patient received a kidney and BMT from the same donor source,' according to the report. 'These patients are currently 7 months to 6 yr status post-living related transplant,' and all have 'functioning bone marrow and kidney transplants, with serum creatinine levels ranging 0.6-1.2 mg/dL.'
'There have been no episodes of rejection,' published results indicated. 'One patient with a history of grade III skin and grade IV gastrointestinal graft-vs.-host disease (GI-GVHD) prior to transplantation, had a mild flare of GI-GVHD (grade I) post-renal transplant and is currently asymptomatic.'
'The incidence of opportunistic infection has been comparable with our pediatric renal transplant population without prior BMT,' study data showed. 'One patient was treated for basal cell carcinoma via wide local excision.'
'Renal transplantation is an excellent option for the treatment of pediatric patients with ESRD following BMT. Short-term results in this small population show promising patient and graft survival, however long-term follow-up is needed,' the researchers concluded. 'Patients who have undergone renal transplantation following BMT are at high risk for opportunistic infections and malignancy, and need life-long medical surveillance.'
Thomas and colleagues published the results of their study in Pediatric Transplantation (Successful renal transplantation following prior bone marrow transplantation in pediatric patients. Pediatr Transplant, 2004;8(5):507-512).
For additional information, contact S.E. Thomas, University of Michigan, C.S. Mott Children's Hospital, Pediatric Nephrology Section, Pediatric Kidney Transplantation Program, Division of Pediatric Nephrology, F6865-Box 0297, Ann Arbor, MI 48109, USA.
The publisher of the journal Pediatric Transplantation can be contacted at: Blackwell Munksgaard, 35 Norre Sogade, P.O. Box 2148, DK-1016 Copenhagen, Denmark.
The information in this article comes under the major subject areas of Hematology, Immunology, Pediatric, Renal, Stem-Cell Transplantation and Surgical Technology.
This article was prepared by Health & Medicine Week editors from staff and other reports. Copyright 2004, Health & Medicine Week via NewsRx.com & NewsRx.net.