title: Retrospective analysis of renal transplantation outcomes in children admitted to a paediatric intensive care unit in Brazil.
abstract: Renal transplantation has been described as the main treatment for children with end-stage renal disease. Traditionally, infants and small children represented a high-risk group with poor allograft survival. However, studies conducted mainly in developed countries have been demonstrated improvements in allograft survival rates. The aim of this study was to identify demographic characteristics of recipients and kidney donors and to analyse the outcomes of children who received postoperative care following renal transplantation in one Paediatric Intensive Care Unit (PICU). This retrospective study was carried out in a university hospital in Brazil. The data were collected through reviewing the follow up of medical records of recipients and kidney donors between 1988 and 2002. Chi-square or Fisher exact tests were used to analyse differences in outcome between living and donor transplants, whereas Mann-Whitney and Kruskal-Wallis tests were used to compare differences in outcome by age groups and by the number of complications affecting recipients. A total of 44 children were admitted for renal transplantation. Within this group, the median age was 10.1(+/-3.2) years, 63.6% were men and 38% were non-Caucasians. In contrast, the donor group had a median age of 17.5(+/-12.5) years, of which 51.3% were male, 56.8% were Caucasian and 70.5% were cadaver donors. The average length of PICU stay was 31.4 h, with complications being identified in the majority of the transplanted children. The occurrence of four or more complications was significantly associated with acute rejection (p= 0.009). In conclusion, the main outcomes of this study were similar to those observed in developed countries, in terms of acute rejections (52.3%), dialysis resumption (31.8%), graft loss (29.5%), chronic rejections (9.1%) and death (4.5%). Complications during PICU stay were significantly linked to the occurrence of acute rejection.
authors: Nursing Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Denise Miyuki
authors: DM
authors: Kusahara
authors: Patricia Kuerten
authors: PK
authors: Rocha
authors: Maria Angélica S
authors: MA
authors: Peterlini
authors: Mavilde L G
authors: ML
authors: Pedreira
authors: Werther Brunow
authors: WB
authors: de Carvalho
mesh_terms: D000293:Adolescent; D001938:Brazil; D016009:Chi-Square Distribution; D002648:Child; D016638:Critical Illness / Q000451:nursing; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D015278:Intensive Care Units, Pediatric; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome