Circulation and Hemodynamics in Living Donation of Kidney Transplantation in Children

Adequate perfusion of an adult-sized renal graft in children demands
significant hemodynamic changes after transplantation (Tx). Suboptimal renal
graft perfusion due to inadequate hemodynamic adaptation increases the risk of
loss of renal graft mass and function. This risk is especially large in the
smaller and younger recipients. Current monitoring of renal graft perfusion in
the post transplantation period is insufficient to detect early deterioration
in blood supply. Goal of this study is to develop a non-invasive, bed-side
monitor for renal perfusion after pediatric kidney transplantation.
Moreover, pharmacokinetic changes after adult sized kidney transplantation in
young children are largely unknown As significant changes are expected, caused
by increased renal and possibly hepatic blood flow, this study will investigate
the pharmacokinetic (Pk) model of several pharmacons in this specific patient
group.

Primary objective is to design a non-invasive, bedside monitoring strategy for
early detection of renal graft hypoperfusion after pediatric kidney
transplantation, using transabdominal ultrasonography and biomarker
surveillance in serum and urine.
Secondary objective is to define a pharmacokinetic (Pk) model for adult sized
kidney transplantation in children.

This is a prospective clinical pilot study.

The extra burden for the participants consists of blood sampling, additional
MRI and ultrasound investigations in addition to standard of care in pediatric
kidney transplantation. In small children this implies an extra anesthesia
session for the performance of the last MRI. Extra blood samples will be drawn
as part of regular blood sampling in standard of care and will not exceed the
maximum allowable amounts.
Benefits are especially accounted for the future pediatric kidney transplant
patients. Though, imaging the renal graft during follow up can also benefit the
study subjects as it is able to detect early deterioration in renal graft blood
supply and perfusion. This study can only be done in this patient group as
hemodynamic changes are age and body-weight specific and especially the
smallest recipients are at risk for inadequate renal graft perfusion because of
large allograft-recipient size mismatch. Adult data about hemodynamic
responses, renal graft perfusion and pharmacokinetic changes cannot be
extrapolated to the pediatric population.