Beyond Survival: A 12-Year Chronicle of Pediatric Kidney Transplantation in Kazakhstan

Deniza Suleimenova 1 2 * , Saltanat Rakhimzhanova 2, Aidos Bolatov 3 4, Ardak Ainakulov 5, Sholpan Altynova 6, Yuriy Pya 7
More Detail
1 School of Medicine, Nazarbayev University, Astana, Kazakhstan
2 Clinical Academic Department of Pediatrics, “University Medical Center” Corporate Fund, Astana, Kazakhstan
3 Department of Science, “University Medical Center” Corporate Fund, Astana, Kazakhstan
4 Shenzhen University Medical School, Shenzhen University, Shenzhen, China
5 Clinical Academic Department of Pediatric Surgery, “University Medical Center” Corporate Fund, Astana, Kazakhstan
6 Department of Medical and Regulatory Affairs, “University Medical Center” Corporate Fund, Astana, Kazakhstan
7 Clinical Academic Department of Cardiac Surgery, “University Medical Center” Corporate Fund, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 5, pp. 10-16. https://doi.org/10.23950/jcmk/16876
OPEN ACCESS 921 Views 114 Downloads
Download Full Text (PDF)
Author Contributions: Conceptualization, D.S., S.R. and A.A.; methodology, D.S. and S.R.; validation, S.R.; formal analysis, A.B.; investigation, D.S. and G.R.; resources, S.R.; data curation, D.S. and S.R.; writing – original draft preparation, D.S. and S.R.; writing – review and editing, S.R., and A.B.; visualization, A.B.; supervision, Sh.A. and Y.P.; project administration, Sh.A. and Y.P.; funding acquisition, Sh.A. and Y.P. All authors have read and agreed to the published version of the manuscript.

Data availability statement: The corresponding author can provide the data supporting the study's conclusions upon request. Due to ethical and privacy constraints, the data are not publicly accessible.

ABSTRACT

Pediatric kidney transplantation (KTx) is a life-saving procedure for children with end-stage renal disease (ESRD), yet outcomes and risk factors remain underreported in Central Asia. We aimed to provide valuable insights into the long-term impact of KTx on pediatric patients.
Materials and methods: This article presents a retrospective review of 12-year experience of pediatric KTx at the «University Medical Center» Corporate Fund (Astana, Kazakhstan). The analysis included the records of 146 patients under the age of 18. The characteristics of the patients included causes of chronic kidney disease (CKD), clinical features and transplantation outcomes: overall survival (OS), graft survival (GS), graft loss (GL), transplant rejection (TR) and complications.
Results: Of 146 recipients (mean age 139 months, 56.8% male), the leading cause of ESRD was congenital anomalies of the kidney and urinary tract (CAKUT, 50.7%). Living donor KTx (LDKT) accounted for 73%, while Deceased donor KTx (DDKT). TR occurred in 18.5% of cases and was significantly associated with GL (OR = 7.19, 95% CI: 2.55-20.25, p < 0.001). GL occurred in 13.0% of patients, and mortality was 6.2%. Complications were reported in 43.8% of patients and were significantly associated with mortality (p = 0.034). No association between donor type (LDKT vs. DDKT) and rejection was found. Gender, diagnosis, BMI, age at transplantation, donor type were not significant predictors of GL or patient death.
Conclusion: Pediatric KTx in Kazakhstan demonstrates promising outcomes, with relatively low mortality (6.2%) and GL (13.0%) rates. TR (occurred in 18.5% patients) significantly predicts GL, while post-Tx complications (occurred in43.8% of patients) are associated with decreased patient survival. These findings support the need for improved early monitoring and long-term management strategies to optimize outcomes.
Keywords: kidney transplantation, child, graft loss, rejection, complication, survival analysis
Keywords: kidney transplantation, child, graft loss, rejection, complication, survival analysis

CITATION

Suleimenova D, Rakhimzhanova S, Bolatov A, Ainakulov A, Altynova S, Pya Y. Beyond Survival: A 12-Year Chronicle of Pediatric Kidney Transplantation in Kazakhstan. J CLIN MED KAZ. 2025;22(5):10-6. https://doi.org/10.23950/jcmk/16876

REFERENCES

  • Bobanga ID, Vogt BA, Woodside KJ, Cote DR, Dell KM, Cunningham RJ, Noon KA, Barksdale EM, Humphreville VR, Sanchez EQ, Schulak JA. Outcome differences between young children and adolescents undergoing kidney transplantation. J Pediatr Surg. 2015;50(6):996-999.https://doi.org/10.1016/j.jpedsurg.2015.03.021.
  • Pape L, Becker JU, Immenschuh S, Ahlenstiel T. Acute and chronic antibody-mediated rejection in pediatric kidney transplantation. Pediatr Nephrol. 2015;30(3):417-424. https://doi.org/10.1007/s00467-014-2851-2
  • Groothoff JW, Cransberg K, Offringa M, van de Kar NJ, Lilien MR, Davin JC, Heymans HSA. Long-Term Follow-Up of Renal Transplantation in Children: A Dutch Cohort Study. Transplantation. 2004;78(3):453-460. https://doi.org/10.1097/01.TP.0000128616.02821.8B
  • Baimakhanov BB, Chormanov AT, Ibragimov RP, Madadov IK, Syrymov ZM. Current status of cadaveric kidney transplantation in Kazakhstan. Vestn Khir Kazakhst. 2019; (1): 39-42.https://cyberleninka.ru/article/n/current-status-of-cadaveric-kidney-transplantation-in-kazakhstan
  • Bolatov A, Asanova A, Abdiorazova A, Pya Y. Too uncertain to consent, too supportive to refuse: the sociocultural dilemma of hesitant organ donors in Kazakhstan. Front Public Health. 2025;13:1602008. https://doi.org/10.3389/fpubh.2025.1602008
  • Bolatov A, Asanova A, Daniyarova G, Sazonov V, Semenova Y, Abdiorazova A, Pya Y. Barriers and willingness to express consent to organ donation among the Kazakhstani population. BMC Public Health. 2025;25(1):842. https://doi.org/10.1186/s12889-025-22044-4
  • Semenova Y, Shaisultanova S, Beyembetova A, Asanova A, Sailybayeva A, Novikova S, Myrzakhmetova G, Pya Y. Examining a 12-year experience within Kazakhstan's national heart transplantation program. Sci Rep. 2024; 14(1):10291. https://doi.org/10.1038/s41598-024-61131-1
  • Baimakhanov Z, Kaniev S, Doskhanov M, Sadykov C, Serikuly E, Skakbayev A, Ilyassova B, Baiguissova D, Seisembaev M, Chormanov A, Baimakhanov B. Evolution of liver transplantation in Kazakhstan: Two-era experience of a single center, the first report. Transpl Proc. 2019; 51(10): 3360-3363. doi:10.1016/j.transproceed.2019.07.023
  • Baigenzhin A, Doskaliyev Z, Tuganbekova S, Zharikov S, Altynova S, Gaipov A. Organ transplants in Kazakhstan. Exp Clin Transplant. 2015; 13 Suppl 3:4-6. https://doi:10.6002/ect.tdtd2015.L5
  • Altynova Sh, Rakhimzhanova S, Issakov S, Ainakulov A, Kuttymuratov G, Abdiorazova A, Daniyarova G, Shaisultanova S, Sailybayeva A, Pya Y. Kidney transplantation in children in the Republic of Kazakhstan. J Health Dev. 2024;57(3):48-52. https://doi:10.32921/2225-9929-2024-3-57-48-53
  • Asanova A, Bolatov A, Suleimenova D, Daniyarova G, Sailybayeva A, Altynova S, Pya Y. The Determinants of Psychological Well-Being Among Kidney Transplant Recipients in Kazakhstan: A Cross-Sectional Study. J Clin Med. 2025 Apr 23;14(9):2894. https://doi.org/10.3390/jcm14092894
  • Kawabe M, Yamamoto I. Current status and perspectives on recurrent IgA nephropathy after kidney transplantation. Nephron. 2023; 147 Suppl 1:9-13. https://doi.org/10.1159/000530341
  • Alasfar S, Matar D, Montgomery RA, Desai N, Lonze B, Vujjini V, Estrella MM, Manllo DJ, Khneizer G, Sever S, Reiser J, Alachkar N. Rituximab and therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis post kidney transplantation. Transplantation. 2018; 102(3):e115-e120. https://doi.org/10.1097/TP.0000000000002008
  • Guild WR, Harrison JH, Merrill JP, Murray J. Successful homotransplantation of the kidney in an identical twin. Trans Am Clin Climatol Assoc. 1955-1956; 67:167-173. https://pmc.ncbi.nlm.nih.gov/articles/PMC2248870/
  • Gupta KL, Pattanashetti N, Ramachandran R, Nada R, Aggarwal R, Sharma A. Renal Transplant and Its Outcomes: Single-Center Experience From India. Exp Clin Transplant (2019) 1: 78-82 https://doi.org/10.6002/ect.MESOT2018.O14
  • Srivastava A, Kumar J, Sharma S, Abhishek, Ansari MS, Kapoor R. Vascular complication in live related renal transplant: An experience of 1945 cases. Indian J Urol. 2013; 29(1):42 -47. https://doi.org/10.4103/0970-1591.109983
  • Bayanova M, Zhenissova A, Nazarova L, Abdikadirova A, Sapargalieyva M, Malik D, Bolatov A, Abdugafarov S, Assykbayev M, Altynova S, Pya Y. Influence of genetic polymorphisms in CYP3A5, CYP3A4, and MDR1 on tacrolimus metabolism after kidney transplantation. J Clin Med Kaz. 2024;21(2):11–17. https://doi.org/10.23950/jcmk/14511
  • Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children: A systematic review. Pediatr Nephrol. 2012 Jun 29;27(3):363–373. https://doi.org/10.1007/s00467-011-1939-1.
  • Otukesh H, Hoseini R, Rahimzadeh N, Fereshtehnejad SM, Simfroosh N, Basiri A, Sharifian M, Hoseini Hashemi G, Falahzadeh H, Derakhshan A, Fazel M, Reiesee D, Sayedzadeh A, Vazirian S, Nikibakhsh AA, Ghafari Moghadam A, Mohamadzadeh H, Naderi A, Isfahani T, Larijani F, Shorkhi H, Akbarzadeh Pasha A, Shahbazian H, Valavi E, Mortazavi F, Gheisari A. Outcome of renal transplantation in children: a multi-center national report from Iran. Pediatr Transplant. 2011 Aug;15(5):533-8. https://doi.org/10.1111/j.1399-3046.2011.01507.x
  • Harada R, Hamasaki Y, Okuda Y, Hamada R, Ishikura K. Epidemiology of pediatric chronic kidney disease/kidney failure: learning from registries and cohort studies. Pediatr Nephrol 2022; 37, 1215–1229; https://doi.org/10.1007/s00467-021-05145-1
  • Said SHA, Agha SH, Abdulla GF, Jaafar MS, Bapir R, Hama NH, Aghaways I, Rashid AO, Abdalla BA, Kakamad FH. Pediatric renal transplantation: a single center experience. Arch Ital Urol Androl. 2024; 96(2). https://doi.org/10.4081/aiua.2024.12389
  • Engels G, Döhler B, Tönshoff B, Oh J, Kruchen A, Müller I, Süsal C. Maternal versus paternal living kidney transplant donation is associated with lower rejection in young pediatric recipients: A Collaborative Transplant Study report. Pediatr Transplant. 2022; 26(1):e14154. https://doi.org/10.1111/petr.14154
  • Abdiyeva A, Tazhikenova G, Seisenova D. Desensitization in kidney transplantation: Review. J Clin Med Kaz. 2024;1(71):29–34. https://doi.org/10.23950/1812-2892-JCMK-011423
  • Trnka P, McTaggart SJ, Francis A. The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation. Pediatr Transplant. 2018; 22(7):e13265. https://doi.org/10.1111/petr.13265
  • Chesnaye NC, van Stralen KJ, Bonthuis M, Groothoff JW, Harambat J, Schaefer F, Canpolat N, Garnier A, Heaf J, de Jong H, Sørensen SS, Tönshoff B, Jager KJ. The association of donor and recipient age with graft survival in paediatric renal transplant recipients in a European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplantation Association Registry study. Nephrol Dial Transplant. 2017; 32(11):1949-1956. https://doi.org/10.1093/ndt/gfx261
  • Winterberg PD, Garro R. Long-Term Outcomes of Kidney Transplantation in Children. Pediatr Clin North Am. 2019 Feb;66(1):269-280. https://doi.org/10.1016/j.pcl.2018.09.008
  • Rahimzadeh N, Otukesh H, Seirafianpour F, Hoseini R. Long-Term Outcome of Kidney Transplant Among Iranian Children: A Systematic Review and Meta-Analysis. Exp Clin Transplant. 2022;20(10):895-900. https://doi.org/10.6002/ect.2020.0274
  • Sazonov, V., Zhailauova, A., Altynova, S., Bayanova, M., Daniyarova, G., Bolatov, A., & Pya, Y. (2024). Metabolomics in search of noninvasive biomarkers for allograft rejection in pediatric kidney transplantation. J Clin Med Kaz, 21(6), 11–17. https://doi.org/10.23950/jcmk/15571
  • Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W. Pearls and pitfalls in pediatric kidney transplantation after 5 decades. Front Pediatr. 2022; 10:856630. https://doi.org/10.3389/fped.2022.856630