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SHOULD PAEDIATRIC RENAL TRANSPLANTATION BE PERFORMED BY
PAEDIATRIC UROLOGISTS AND SURGEONS?
Liam Sean Lloyd MCCARTHY
1
, Peng ONG
2
, Nick INSTON
3
, David MILFORD
4
, Sally HULTON
4
and Khalid SHARIF
2
1) Birmingham Children's Hospital, Paediatric Urology, Birmingham, UNITED KINGDOM - 2) Birmingham Children's
Hospital, Hepatobiliary and Transplantation, Birmingham, UNITED KINGDOM - 3) University Hospital Birmingham, Renal
Transplantation, Birmingham, UNITED KINGDOM - 4) Birmingham Children's Hospital, Paediatric Nephrology,
Birmingham, UNITED KINGDOM
PURPOSE
Historically Paediatric renal transplants (PRT) were performed by adult transplant surgeons (who may have had little
paediatric surgery/urology training, but a lot of adult transplant experience). Paediatric transplant surgeons and
urologists (PTS&U) by definition operate on children, but the volume of paediatric renal transplantation is much smaller.
Since 2009 PRT at our centre have been performed by PTS&U, supported by adult surgeons. Is PRT best delivered by a
PTS&U-led multi-disciplinary team (MDT)?
MATERIAL AND METHODS
A 20-year retrospective study was performed. Age at renal transplantation, and survival of the graft until either death or
graft failure (start of dialysis) was collected. Kaplan-Meier survival was calculated for the historical adult-only MDT and
compared to recent paediatric-led MDT. An analysis of children 5-years and under and was also performed. Log-rank
and Fisher exact test were used respectively, p<0.05 taken as significant.
RESULTS
Since 1995, 204 PRT been performed at our centre (in 195 patients). Before 2009, 135 were performed by adult
transplant surgeons. Subsequently 69 PRT have been performed by PTS&U-led MDT. The 5-year graft survival of the
historic cohort was 83%, vs. 98% for the subsequent paediatric surgeons’ cohort, p<0.01.
Of 18 PRT performed in the historic cohort in patients 5-years and under, 4 had graft loss or death; whereas all 21
grafts in the recent paediatric-led cohort survived, p <0.05.
CONCLUSIONS
The delivery of paediatric renal transplantation by a team led by paediatric transplant surgeons and urologists, with
support by adult transplant team, has significantly improved outcome in renal transplantation, especially in smaller
children.