{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:46:47Z","timestamp":1761630407023},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2006,3,7]],"date-time":"2006-03-07T00:00:00Z","timestamp":1141689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2006,6]]},"abstract":"<jats:p><jats:bold>Abstract:\u2002<\/jats:bold><jats:bold> Introduction:\u2002<\/jats:bold> Renal transplantation is established as the standard of care for end\u2010stage renal failure (ESRF) in the developed world. In emerging nations, the appropriateness of such costly interventions has been questioned. We undertook an analysis of all renal transplants undertaken under the care of the pediatric nephrology service at the Johannesburg Hospital, South Africa, in order to establish the outcomes of a transplantation service in a resource\u2010constrained environment in a developing country.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> This was a retrospective review of renal transplantation undertaken at a single teaching hospital in Johannesburg, part of the University of the Witwatersrand. Two hundred and eighty\u2010two transplants were performed between 1984 and 2003. Demographic characteristics of the transplanted population, diagnosis, morbidity, graft survival, and mortality were recorded.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Overall 1\u2010, 5\u2010, and 10\u2010yr graft survival was 82, 44, and 23%. Overall 1\u2010, 5\u2010, and 10\u2010yr patient survival was 97, 84, and 68%. The median graft survival for all transplantation episodes was 4.38\u2003yr; 70% of patients survive 10\u2003yr and 54% survive 20\u2003yr or more. Although early graft survival was good, there was a more rapid rate of graft loss than when compared to results from developed centers with much poorer results at 5 and 10\u2003yr. Causes of ESRF show marked variation between the races, and black patients have significantly worse outcomes than others. Compared with white patients, black recipients received fewer living donor kidneys (26 vs. 10%, p\u2003=\u20030.0019), a greater proportion of totally mismatched organs (56 vs. 36%, p\u2003=\u20030.015), less pre\u2010emptive transplantation (7 vs. 35%, p\u2003=\u20030.0001) and experienced a higher rate of primary non\u2010function (13 vs. 3%, p\u2003=\u20030.004). Surgical complications of transplantation occurred in 9% of recipients, but rarely led to graft loss.<\/jats:p><jats:p><jats:bold>Conclusion:\u2002<\/jats:bold> Pediatric renal transplantation in Johannesburg can be accomplished with low complication rates, but medium and long\u2010term graft survival is poor when compared with contemporary results achieved in developed countries. The difficulties of undertaking such complex, multidisciplinary interventions in a developing nation are daunting, but we believe that renal transplantation should still be the treatment of choice for all children with ESRF. The poorer outcomes in black recipients can be addressed by increasing education in our communities and expanding the pool of appropriate donors. Better institutional support would allow for improved long\u2010term patient care.<\/jats:p>","DOI":"10.1111\/j.1399-3046.2006.00489.x","type":"journal-article","created":{"date-parts":[[2006,3,7]],"date-time":"2006-03-07T14:33:38Z","timestamp":1141742018000},"page":"441-448","source":"Crossref","is-referenced-by-count":22,"title":["Pediatric renal transplantation in a South African teaching hospital: A 20\u2010year perspective"],"prefix":"10.1111","volume":"10","author":[{"given":"G. J.","family":"Pitcher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. G.","family":"Beale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. M.","family":"Bowley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. D.","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,5,19]]},"reference":[{"key":"e_1_2_7_2_2","unstructured":"Constitution ofTheRepublic ofSouthAfrica\u2013 Chapter2 \u2013 Bill of rights. (Act 108 of 1996).1996. 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Internet Communication."},{"key":"e_1_2_7_10_2","first-page":"429","article-title":"International child health","volume":"15","author":"Saloojee H","year":"2005","journal-title":"10\u2003yr of democracy in South Africa; the challenges facing children today"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199404150-00014"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199209173271203"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200103150-00021"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200301000-00023"},{"key":"e_1_2_7_15_2","first-page":"419","article-title":"An assessment of the effectiveness of the Mottep model for increasing donation rates and preventing the need for transplantation \u2013 adult findings","volume":"21","author":"Callender CO","year":"2001","journal-title":"program years 1998 and 1999"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200212000-00012"},{"key":"e_1_2_7_17_2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.7182\/prtr.1.8.4.k310u6n837433540","article-title":"Attitudes of black South Africans concerning organ donation","volume":"8","author":"Ndlovu SR","year":"1998","journal-title":"J Transplant Coord"},{"key":"e_1_2_7_18_2","first-page":"417","article-title":"Health economic evaluations","volume":"22","author":"Winkelmayer WC","year":"2002","journal-title":"the special case of end-stage renal disease treatment"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200107270-00017"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00860742"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199607270-00007"},{"key":"e_1_2_7_22_2","first-page":"15","article-title":"Is total lymphoid irradiation preparation indicated in pediatric renal transplantation?","volume":"26","author":"Thomson PD","year":"1994","journal-title":"Transplant Proc"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1399-3046.2006.00489.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1399-3046.2006.00489.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T18:35:37Z","timestamp":1697308537000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1399-3046.2006.00489.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,5,19]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2006,6]]}},"alternative-id":["10.1111\/j.1399-3046.2006.00489.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1399-3046.2006.00489.x","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,5,19]]}}}