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Present outcomes and future challenges
Renal transplantation is undoubtedly the treatment of choice for children with end stage renal failure. While great advances have been made in the field of renal replacement therapy, the provision of dialysis and associated therapies places major restrictions on the child and their family. Poor weight gain and linear growth may necessitate supplementary feeding and/or recombinant growth hormone, and further dietary restrictions are imposed by the potassium and phosphate restricted diets that are necessary. Children also require oral and subcutaneous drug therapy for the treatment and prevention of anaemia, renal osteodystrophy, and hypertension. Psychomotor development is retarded and this is compounded by the imposition on normal childhood activities and interference with schooling associated with haemodialysis and, to a lesser extent, peritoneal dialysis.
The restoration of normal or near normal renal function by transplantation allows a number of these difficult and time consuming therapies to stop and may facilitate better growth and neurodevelopment. Furthermore, adult data clearly show transplantation to be more cost effective and associated with a reduction in long term mortality and improvement in quality of life compared with long term dialysis.1
In 2001, a total of 136 kidney transplants were performed in paediatric recipients (defined as under 18 years of age) in the United Kingdom, representing 8.1% of kidney transplants performed overall. This editorial reviews the current status of paediatric renal transplantation and explores the prospects for the future.
ORGAN DONATION AND ALLOCATION
At present, around 75% of UK paediatric transplants are performed using organs from both adult and paediatric cadaveric donors. The cadaveric organ donation rate in the UK in 2001 was 13.1 per million population (pmp) representing a total of 777 donors. This rate of donation, which has been relatively stable over recent years, is one of the lowest in Europe. In nations such …
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