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Outcomes after liver transplantation in accordance with ABO compatibility: a systematic review and meta-analysis World J Gastroenterol 2017;23(35):6516–33 134 Mysore KR, Himes RW, Rana A, Teruya J, Desai MS, Srivaths PR, et al ABO-incompatible deceased donor pediatric liver transplantation: novel titer- based management protocol and outcomes Pediatr Transplant 2018;22(7):e13263 Evaluating and Preparing the Pediatric Dialysis Patient for Kidney Transplantation 49 Sandra Amaral and Lars Pape Introduction Historical Context The field of transplantation is fairly new in the context of medical history The first successful kidney transplant occurred in identical twin young adult brothers in December 1954 in Boston, Massachusetts in the United States The recipient died 8 years later of causes unrelated to the transplant [1] In the 1960s, the majority of children with end-stage renal failure died because no adequate treatments were available It was not until the mid-late 1960s that immunosuppressive treatments were developed to enable successful transplantation using either living or deceased donors and across immunological barriers In the mid-seventies, pediatric and adolescent hemodialysis and transplantation programs were set up in many industrialized countries, increasing the chances of survival for the first time for patients with end-stage renal failure At that time, approximately 120 children and adolescents with end-stage renal failure underwent kidney transplant surgery each year per 100 million population With an incidence rate of S Amaral (*) The Children’s Hospital of Philadelphia, Pediatrics, Division of Nephrology, Philadelphia, PA, USA e-mail: amarals@email.chop.edu L Pape University Hospital of Essen, Department of Pediatrics II, Essen, Northrhine-Westfalia, Germany approximately 120 new cases of end-stage renal failure per 100 million population, the number of children and adolescents on the transplant list has remained stable with approximately 6–8 children per one million children 18 months had an 89% higher risk of mortality (HR 1.89; 95% CI: 1.32–2.70) [3] Similarly, a large-scale study in Australia and New Zealand of 1634 children and adolescents starting renal replacement therapy before the age of 20 showed a four-fold (hemodialysis) to five-fold (peritoneal dialysis) increase in the mortality rate with dialysis therapy compared to successful renal transplantation [4] The benefits of renal transplantation versus dialysis therapy in terms of survival rates were outlined most impressively in a recent report of the United States Renal Data System (USRDS) Compared to dialysis therapy, successful renal transplantation improved life expectancy in all age groups, with the most striking increase being noted in children and adolescents [2] In children aged 0–14 years, successful renal transplantation improved the remaining life expectancy post-transplantation by 30 years; the average life expectancy for this age group is 50 years For adolescents between 15 and 19 years of age, life expectancy is improved by 25 years with a mean life expectancy of 40 years Therefore, kidney transplantation is clearly the treatment of choice for any form of childhood end-stage renal failure The complications associated with uremia and dialysis therapy can be avoided or at least reduced after prompt, successful renal transplantation [4] Moreover, quality of life is considerably better after a successful renal transplant compared to chronic dialysis treatment [5, 6] Patients can lead a virtually normal life, and apart from the need to take medication and attend outpatient clinics, there are only a few restrictions on everyday life Even growth and physical development are almost normal following successful transplantation [7] Transplant Referral: Timing and Indications Given the clear survival and health-related quality of life benefits to children with a kidney transplant versus chronic dialysis, prompt refer- S Amaral and L Pape ral for transplantation is essential for all children in advanced stages of kidney disease The purpose of the pediatric transplant evaluation is to identify any potentially modifiable surgical, medical, and psychosocial barriers that may adversely impact optimal patient and graft survival To this end, a robust, multi-disciplinary approach is essential to promote safe and effective transplantation for children and their families Typical components of the pediatric kidney transplant evaluation are presented in Table 49.1 The evaluation is by necessity comprehensive and can be time-consuming Preparations for kidney transplantation are usually initiated when the estimated glomerular filtration rate (eGFR) falls below 20–25 ml/min/1.73 m2 In the United States, children may be waitlisted for deceased donor kidney transplantation at any level of eGFR. This is in contrast to other countries, like those of the Eurotransplant group, or adults over 18 years of age in whom the eGFR must be ≤20 ml/min/1.73 m2 The absence of an eGFR cut-off for waitlisting children in the United States reflects recognition that children with advanced stages of chronic kidney disease may experience substantially impaired growth and nutrition, impaired neurocognitive development, and other medical complications related to their kidney disorder before their eGFR reaches