Pediatric Perspectives Summer 2009 - Cleveland Clinic

Pediatric nephrologists at Cleveland Clinic Children’s
Hospital are excited about the potential of nomograms to
increase graft longevity.
“We do our best to provide the ideal organ for each patient,
with live donors providing the best results. Nomograms
incorporate numerous factors to objectively match a
good donor with the ideal organ recipient. This can only
improve outcomes,” says pediatric nephrologist Charles
Kwon, MD.
Kidney Transplant Nomograms Improve Donor-Recipient Match
A new system of nomograms for kidney transplantation appears to improve the donor-recipient match. The system
has been validated in adult patients, but has implications for pediatric patients, since children receive adult kidneys.
Predicting graft function, survival
The nomograms were developed by Cleveland Clinic
adult and pediatric kidney transplant surgeon David
Goldfarb, MD, and colleagues. They analyzed data from
the United Network for Organ Sharing registry to deter-
mine which factors played key roles in renal function and
graft survival and reported their findings in the March
2009 issue of the Journal of Urology.
The following variables had the greatest impact:
• demographic factors, including donor and recipient
age, gender and size
• immunological factors, such as antigen-antibody
matching immunosuppressive regimens
• organ procurement technique
They then used these factors to develop two nomograms
that predict kidney graft viability at one year. To develop a
third nomogram, predicting five-year graft survival, they
used other variables — delayed graft function, rejection
episodes and estimated glomerular filtration rate at six
months post-transplant.
“When we are better able to match donors and recipi-
ents prior to transplant, we can optimize outcomes and
reduce the likelihood that the patient will need another
kidney in the next five years,” said Dr. Goldfarb.
Ideal match critical for children
Although reducing the need for retransplantation re-
mains a universal goal, achieving an optimal match in
children is critical because best outcomes are seen with
the first transplant.
“When patients develop renal failure at a young age, it
is crucial for their immediate growth and development
— and for their long-term life prospects — to receive a
transplant with the optimal organ as soon as possible,”
says Dr. Kwon.
“The success rate for renal transplantation is high, with a
one-year graft survival rate of more than 90 percent. How-
ever, we are always striving to improve on that rate, and
nomograms may be one tool that can help.”
Kidney transplantation extends length of life and
significantly improves quality of life for both pediatric
and adult recipients.
Kidney donation safe
Kidney donation does not adversely impact a donor’s
health. A study reported in the January 29, 2009, New
England Journal of Medicine found that kidney donors
have survival rates similar to those of the general popula-
tion. A donor’s risk for developing end-stage renal
disease, hypertension, diabetes or cancer was similar to
that of a person of the same age, gender and ethnicity
who was not a donor.
In addition, most donors had their glomerular filtration
rate preserved, normal albumin excretion and an excel-
lent quality of life. The authors found that a donor’s risk
of kidney failure was actually lower than the rate reported
in the general population.
Physicians may reach Dr. Kwon at 216.444.6123 or
kwonc@ccf.org, and Dr. Goldfarb at 216.444.8726
or goldfad@ccf.org.
Cleveland Clinic’s toll-free physician number is 800.553.5056