Native nephrectomy in pediatric transplantation--less is more!
OBJECTIVE
Indications for pre-transplantation native nephrectomy (PTNN) include chronic renal parenchymal infection, proteinuria, intractable hypertension, polycystic kidneys and malignancy. Our aim was to establish the frequency and reasons for PTNN in children undergoing renal transplant at our center.


METHODS
Children listed for renal transplant between 1998 and 2010 who underwent PTNN were analyzed. Etiology of established renal failure, indication for nephrectomy, stage of chronic kidney disease, laterality, complications, and timing of subsequent transplant were determined. Outcome of children, and that of preserved native kidneys following transplant, was reviewed.


RESULTS
21/203 children listed for transplant (10.3%) underwent PTNN (32 nephrectomies). Indications were drug-resistant proteinuria (6 children), recurrent upper tract urosepsis (6), refractory hypertension (4), malignancy/malignant predisposition (4), concomitant procedure during ureterocystoplasty (1). Median age at nephrectomy was 3.3 years; 86% had impaired renal function at time of (first) nephrectomy. Median time until transplantation following bilateral nephrectomy was 1.7 years. 19/21 children have been transplanted; 17 reached stable graft function. Only 2 children who did not undergo PTNN required nephrectomy post-transplant.


CONCLUSIONS
When malignancies were excluded, PTNN was performed in a minority (8.4%) of children, mainly for proteinuria. This adds great advantage by reducing morbidity. Resulting graft function seems favorable.
Department of Paediatric Urology, Kidney Transplant Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK. nia.fraser@nuh.nhs.uk
Nia
N
Fraser
P C
PC
Lyon
A R
AR
Williams
M T
MT
Christian
M U
MU
Shenoy
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000601:surgery; D007223:Infant; D007680:Kidney Neoplasms / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D007690:Polycystic Kidney Diseases / Q000601:surgery; D011507:Proteinuria / Q000601:surgery; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D055502:Secondary Prevention; D014850:Waiting Lists