The following is a summary of “Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics,” published in the November 2023 issue of Nephrology by Puliyanda et al. 

Preparation for kidney transplantation is critical for preventing complications and enhancing survival, with distinct processes varying across age groups. The etiology of end-stage kidney disease (ESKD) differs significantly between adults and pediatric patients, predominantly attributed to diabetes and hypertension in adults and congenital anomalies of the kidney and urinary tract (CAKUT) in pediatric cases.

Immunologic risk assessment is paramount across all age groups before kidney transplantation. Children generally exhibit lower risk due to increased living donor transplants with better HLA matching, while adults face higher immunological risks, especially with second transplants and deceased donors. Comprehensive documentation of sensitizing events and measurement of panel reactive antibodies are crucial steps.

Kidney donors play a crucial role, with living donation being more prevalent in lower-income countries due to limited deceased donor programs. Living donation offers benefits such as shorter waiting list times and improved graft outcomes, though its prevalence varies between countries.

Surgical considerations in adult recipients involve assessing atherosclerotic disease, with severe peripheral arterial disease posing a relative contraindication for transplantation. Pediatric kidney transplantation presents unique challenges, requiring accommodations for adult-sized kidneys in smaller pediatric patients.

Considerations for growth, puberty, and neurodevelopment are essential, especially for pediatric recipients. Medications commonly used in transplantation, like steroids, can disrupt the hormonal growth axis and cause pubertal delay, emphasizing the need for awareness among adult nephrologists.

Recognizing the nuances in pre-, peri-and post-transplant issues for children, adolescents, and adults is crucial for optimal care. This article guides understanding these differences and developing effective management approaches across diverse populations undergoing kidney transplantation.

Source: sciencedirect.com/science/article/abs/pii/S0270929523001523