critique: outcome after renal transplantation in children from native and immigrant families in...

8/12/2019 Critique: Outcome After Renal Transplantation in Children From Native and Immigrant Families in Austria

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Outcome after renal transplantation inchildren from native and immigrant

families in AustriaFatma Zehra Oztek,Osman Ipsiroglu,Thomas Mueller,Christoph Aufricht

Introduction:

Renal transplantation is the therapy of choice for children with end-stage renal disease (ESRD).

Ethnicity affects the transplant survival rates substantially, but there has been no European

academic evaluation of the effects of immigration on the pediatric renal transplantation outcome.

Aim:

The aim of this study was to compare the outcomes of renal transplantation between the

children of immigrant families and the children of native families at the pediatric nephrology unit

of the Medical University of Vienna, Austria.

Methods:

We conducted a retrospective study on all children who underwent renal transplantation at our

center between January 1997 and June 2005. The patients were separated into two groups

according to their immigration backgrounds.

The researchers retrospectively analyzed:

(1) Age at RTx

(2) Sex

(3) Migration Status

(4) Parental education

(5) Employment status

(6) Underlying renal disease

(7) Prior renal replacement therapy

(8) Organ donor source

(9) Cold ischemia time
http://link.springer.com/search?facet-author=%22Fatma+Zehra+Oztek%22http://link.springer.com/search?facet-author=%22Osman+Ipsiroglu%22http://link.springer.com/search?facet-author=%22Thomas+Mueller%22http://link.springer.com/search?facet-author=%22Christoph+Aufricht%22http://link.springer.com/search?facet-author=%22Christoph+Aufricht%22http://link.springer.com/search?facet-author=%22Thomas+Mueller%22http://link.springer.com/search?facet-author=%22Osman+Ipsiroglu%22http://link.springer.com/search?facet-author=%22Fatma+Zehra+Oztek%22


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(10) HLA match

(11) Time from first dialysis to transplantation time (waiting time)

To assess the RTx outcome, the patient and graft survival rates, acute rejection episodes,

rejection-free time, allograft function, growth, and 24-h blood pressure at the last follow-up visit

were analyzed.

Target population:

During the time frame of our study, 59 children underwent a total of 63 transplantations. Of

these children, 42 were from native Austrian and 17 were from first-generation immigrant

families. We analyzed the demographic data and outcome parameters for each of the 59

patients.

Results:

We found no difference in patient and graft survival rates or long-term function between native

and immigrant children. Our retrospective analysis shows no influence of the migration status on

the patient or graft outcome, but we did find that immigrant children benefitted more than native

children from living donation as opposed to deceased donation. To explain this fact, biological,

heath-economical, psychosocial, and cultural background aspects must be investigated.


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Outcome after renal transplantation inchildren from native and immigrant

families in AustriaAqeel Adnan Al-Mahdaly, Maridel Beros, Rona Faye Estrella, Erwin Viviezca

A critique.

The aforementioned MSN students concluded some key points that have not been identified

and some alterations or problem that the researchers may or could include in the study, since

these are major factors that could or may alter and affect the results of the study:

(1) Pathophysiology and disease orientation

Prolonged cold ischemia time

Delayed allograft function

Acute rejection episodes

If there are infections on the target population

Adherence of the target population

Underlying primary disease (they didnt classify it in the study)Increased risk of

recurrent disease is associated with focal glomerulosclerosis, atypical hemolytic uremic

syndrome, and membranoproliferative glomerulonephritis. Obstructive uropathy with

bladder dysfunction is associated with bladder complications, which may affect allograft

function.

Conclusion, genes, not race, determine donor kidney survival

(2) Migration Status

Migration implies differences in lifestyle, dietary and health behavior practice, and adherence, all

of which are relevant factors in terms of disease outcome. However, renal transplantation in

immigrant groups has been rarely studied in Europe.

In the study, they compared natives from the immigrants. In comparison to native recipients,

immigrant recipients (31 boys, 17 girls) tended to be younger and male, which shows that they


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are with a higher rate of congenital renal diseases. The percentage of adolescent immigrant

recipients tended to be lower, and living donation tended to be higher.

In addition, there were no stated migration status in the outcome and they also limit the

classification of the immigrants to first generation only.

(3) Ethnicity

Also, the students concluded that ethnicity affects the transplant survival rate.

(4) Academe and further studies

The students also note that, there were no European academic evaluations that can

support the study for the mean time.

There was a medication change done from 2000-2005 that could alter the result of the

study. There were no censored observations regarding the change of medication noted

on the Kaplan-Meier analysis.

No explanation included in the study on the reason they change the medications and the

possible effect of those changes.

(5) Communication barriers

(6) Further studies:

In comparison to older population:

There is some evidence that patient survival in elderly patients who receive a transplant is

significantly higher compared with those, who remain on dialysis. In general, patient survival

after renal transplantation is mainly dependent on recipient age. Concerning graft survival, most

studies conclude that the survival of kidneys taken from older donors (>50 years) and very

young donors (


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age are important risk factors, which may influence outcome after renal transplantation and

therefore should be considered carefully.

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