[Pediatric kidney transplantation].
OBJECTIVE
To describe indications, surgical aspects, results and outcomes of kidney transplantation in children.


METHODS
An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "kidney transplantation", "pediatric", "children", "outcomes". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 2608 articles. After reading titles and abstracts, 18 were included in the text based on their relevance.


RESULTS
Kidney transplantation is the gold-standard treatment for end stage renal kidney disease in children. The surgical procedure is well standardized with a retroperitoneal approach when child and kidney size allow it or a transperitoneal approach in child less than 15 kg and big size kidney graft. Anastomosis sites include iliac vessels in the retroperitoneal approach, and inferior vena cava and aorta in case of transperitoneal procedure. Ureteral reimplantation used most of the time a Campos Freire technique. Sometimes, particular conditions in the recipient (such as vena cava thrombosis) required procedure adaptation.


CONCLUSIONS
Graft survival dramatically increased over the past few years and is now superior to those observed in adult kidney transplantation, particularly in experienced team with microsurgery skills. Immunosuppressive treatments are similar to adults. Viral infections and post-transplant lymphoproliferative disorder are the main complications of renal transplantation in children and may lead to lethal outcomes. An increase graft loss is observed during boyhood due to immunosuppressive drugs uncompliance.
Service d'urologie et de chirurgie de la transplantation, HCL, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69437 Lyon cedex 03, France. Electronic address: lionel.badet@chu-lyon.fr.
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Badet
Service d'urologie et de chirurgie de la transplantation, HCL, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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Matillon
Service d'urologie et de chirurgie de la transplantation, HCL, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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Codas
Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, université Paris Descartes, 75015 Paris, France.
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Timsit
Service d'urologie et transplantation rénale, université de Montpellier, CHU de Montpellier, 34000 Montpellier, France.
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Thuret
Inserm UMR 1098, service d'urologie et transplantation rénale, université de Franche-Comté, CHRU de Besançon, 25000 Besançon, France.
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Kleinclauss
Service de chirurgie pédiatrique, HCL, hôpital Mère Enfant, université Claude-Bernard Lyon 1, 69437 Lyon, France.
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Demede
D002648:Child; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods; D016896:Treatment Outcome
Children; Kidney transplantation; Outcomes; Pediatric; Pédiatrie; Résultats; Spécificité; Transplantation rénale