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REVIEW ARTICLE
Year : 2014  |  Volume : 8  |  Issue : 5  |  Page : 14-16

Pediatric kidney transplantation in India – The journey so far and the road ahead


Director & Senior Consultant, Paediatric Nephrology, Fortis Institute of Renal Sciences and Transplantation, Vasant Kunj, New Delhi, India

Correspondence Address:
Sanjeev Gulati
Director & Senior Consultant, Paediatric Nephrology, Fortis Institute of Renal Sciences and Transplantation, Vasant Kunj, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijt.2013.11.005

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In the last two decades, transplantation has advanced from an experimental procedure to become the principal goal of pediatric renal programs in the management of children with ESRD. The Pediatric transplant programme at SGPGIMS was started in late 1990s under the leadership of Prof. Sharma. Over the next decade SGPGIMS emerged as one of the leading centres in the country in the field of kidney transplant in children and so far, more than 150 kidney transplants have been performed in children. In an ideal scenario, pre-emptive kidney transplantation is the gold standard as it gives superior patient and graft survival with minimal side-effects. We were amongst the first to perform preemptive kidney transplant in children in India. This approach has a great importance for a country like ours in view of economic benefits because of the cost savings in terms of dialysis expenses. In our initial experience with 39 kidney transplants, a triple drug regimen of Csa, Aza and Prednisone was the cornerstone of immunosuppression in this public sector hospital. We also observed that discontinuation of Csa was a major reason for poorer long team graft survivals. We also found that MMF was a useful alternative in children who developed post transplant HUS secondary to Cyclosprine. In our subsequent experience at SGPGIMS, we changed over to Tacrolimus, MMF and Prednisone as the standard immunosuppressive protocol (6). In contrast quadruple immunosuppression using antibody induction with tacrolimus has been the norm at Fortis Institute. Excellent rehabilitation was observed with most children with functioning grafts, attending their school or college normally, doing well in both curricular and extracurricular activities.


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