Kidney transplantation in pediatric recipients with mental retardation: clinical results of a multicenter experience in Japan.
BACKGROUND
There are few published reports on kidney transplantation (KT) in physically handicapped patients with mental retardation. The aim of this study is to clearly identify the outcome of KT in these patients and clarify whether handicapped patients can be candidates for KT.


METHODS
Our study identified 25 multiply handicapped transplant recipients from 8 institutions. Causes of mental retardation were chromosomal abnormality in 5 patients, genetic syndrome in 10 patients, developmental brain anomaly in 2 patients, and other or unknown causes in 8 patients. Primary diseases leading to end-stage renal disease were congenital urinary tract anomaly in 12 patients, focal segmental glomerulosclerosis in 3 patients, cystic kidney disease in 3 patients, and other in 7 patients.


RESULTS
Twenty-three patients received living-related transplants from a parent and 2 patients received cadaver transplants. Twenty-two patients were on peritoneal dialysis therapy, 2 patients were on hemodialysis therapy at the time of KT, and 1 patient underwent preemptive KT. Eleven acute rejection episodes occurred in 8 patients. All episodes were completely reversed with treatments that included mainly methylprednisolone pulse therapy. Posttransplantation lymphoproliferative disorder occurred in 2 patients. Follow-up data showed that all grafts were functioning during a mean observation period of 41.1 months (range, 4 to 187 months). All persons providing primary support for patients were satisfied with the KT and believed that quality of life was improved in both transplant recipients and themselves.


CONCLUSIONS
Results indicate that KT is not contraindicated in handicapped patients, but cannot determine which patients are unsuitable to undergo KT.
Department of Pediatrics, Hiroshima Prefectural Hospital, Hiroshima, Japan. tohta-hph@umin.ac.jp
Toshiyuki
T
Ohta
Osamu
O
Motoyama
Kota
K
Takahashi
Motoshi
M
Hattori
Seiichiro
S
Shishido
Naohiro
N
Wada
Yoshimitsu
Y
Gotoh
Toshio
T
Yanagihara
Akira
A
Hasegawa
Takashi
T
Sakano
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome