Increase driven by national rise in FSGS cases and more lives saved through fetal care

Surgeons at Cincinnati Children’s performed 34 kidney transplants in 2013 – more than any other pediatric medical center in the US.

In past years, no more than 30 children had received kidney transplants in a single year, says Jens Goebel, MD, medical director of kidney transplantation at Cincinnati Children’s. Goebel says the latest increase was driven by two factors.

Focal segmental glumerosclerosis (FSGS) has been steadily rising in the US for more than a decade. This scarring of the microscopic filters in the kidneys can vary in severity, with the most extensive damage requiring transplantation to treat.  In children, FSGS is the most common cause of end-stage kidney disease predominantly affecting these filters.

“There is evidence that FSGS is on the rise. Nobody really knows why FSGS is on the rise, but the obesity epidemic may be one of the explanations for the increase,” Goebel says.

As an NIH Center of Excellence researching the causes and potential treatments for FSGS, more children with advanced disease are being referred to Cincinnati Children’s.  As a result, the medical center is performing more FSGS-related kidney transplants. Also, through adopting the latest post-transplant treatments, Cincinnati Children’s has established a strong track record at preventing FSGS recurrence after transplantation. 

Successful fetal care treatments are helping more infants reach and survive birth despite developing bladder outlet obstructions in the womb.  As part of the Cincinnati Fetal Center, Cincinnati Children’s is one of only a few medical centers in the country performing these treatments.

“Ten years ago, this type of condition was not considered survivable. But with fetal treatments and early dialysis, they have become not just survivable but ultimately associated with acceptable medical and quality-of-life outcomes,” Goebel says.

Cincinnati Children’s also is one of the few centers offering kidney dialysis for newborns, a highly specialized service that has allowed more infants with kidney failure to survive and grow large enough to receive transplants at about 18 months of age.

“The combination of fetal care and infant dialysis has made it possible to save and improve more lives,” Goebel says. “We have seen a significant increase in the number of transplants among children less than 3 years old in the past two years. And even with the increasing complexity of these cases, our outcomes remain cutting-edge.”