Renal transplantation in Thai children.

Renal transplantation in children has been performed for over 25 years in developed countries but has never been reported in Thai children. We report an 8 year-old girl with end-stage renal disease due to chronic glomerulonephritis who had been transplanted at Siriraj Hospital. She was treated with continuous peritoneal dialysis for 9 months and developed several episodes of bacterial peritonitis and hypertension. She was transplanted using her father’s kidney and her serum creatinine level was normal within 7 postoperative days. The patient developed severe hypertension which was controlled with 4 antihypertensive agents. Five weeks postoperation her new ureter leaked. Although surgery was performed with internal stent placed, the patient continued to have urinary leakage and ureteric reconstruction using bladder flap or her own ureter will be done later. The patient’s renal function was normal on follow up.

Current status of kidney transplantation in Thailand.

The first kidney transplantation in Thailand was done on March 3, 1972 at Chulalongkorn University Hospital in Bangkok. At present, twenty hospitals (both government and private) are performed this operation. The total number of transplant patients was reported (excluded 4 hospitals) for 750 patients up to September 1995. The average age was 38 years and the male to female ratio was 3:2 (450:300). The chronic glomerulonephritis is the leading cause of end stage renal diseases. Other causes were nephrosclerosis, stone, diabetes, polycystic kidney disease, IgA nephropathy and interstitial nephritis of unknown etiology. The replacement was CAPD and hemodialysis in an average ratio of 20:80. The donor were 86% cadaveric and 14% living related donors. The one year success rate was 95% with living donors and 87% with cadaveric donors; after five years was 82% with living and 64% with cadaveric donors. The major causes of graft loss were chronic rejection, infection and vascular complications (renal artery stenosis or renal vein thrombosis). The causes of death were studied in 122 patients. All of them survived more than five years. Forty percent (49 patients) died from infection; thirty nine percents (47) denied further dialysis treatments. The rest from other organ failure (11), heart diseases (3) and two were unknown cause. The sources of major infections were bacterial (23 patients), two of them were tuberculosis. The other were viral (HSV, HB and unknown) only two CMV were suspected and two were Cryptococcus infections. The urological complications were reported in 55 patients; forty percents (22) was urinary leakage. The immunosuppressive agents were prednisolone, cyclosporine A, azathioprine with occasionally ALG and OKT3. The double regimen of prednisolone + cyclosporine A accepted for more than 70%. The brain death criteria was submitted by the National Medical Board Meeting was accepted for our cadaveric donors.