Experience with 129 Pediatric (<21 yr) Kidney Transplantations

ABSTRACT

BACKGROUND: Renal transplantation has become widely accepted as the treatment of choice for children with end-stage renal disease (ESRD). Two important criteria for successful pediatric renal transplantation are achievement of optimal growth, developement, and possession of a long functioning renal transplant. METHODS: In order to establish better strategies for successful pediatric renal transplantation outcome, we reviewed the results of 129 primary renal transplantations performed at our institution. One hundred twenty-nine renal allografts were transplanted to 129 pediatric ESRD patients under the age of 21 between July 1979 and November 1997. Mean age at transplantation was 13.4 yrs ( or =10 yrs 100) and male to female ratio was 8742. Original renal diseases were known in 90 recipients (69.8%) including 7 congenital or hereditary diseases (5.4%). Donor kidneys were obtained from 93 living-related donors (LRD), 20 living-unrelated donors (LUD), and 16 cadavers (CAD). Mean follow-up period was 57.8 months. Immunosuppression was done with AZA Pds (n=5) before 1985 and with CyA Pds (n=79) and AZA CyA Pds (n=45) thereafter. RESULTS: Twenty five grafts were lost (20.7%) due to 20 chronic rejections, 3 recurrences of the original renal disease and 2 patient deaths with functioning graft. Overall 1-, 3-, 5-, 10-yr graft and patient survival rates were 95.1%, 88.2%, 80.2%, 61.0% and 98.5%, 96.7%, 95.2%, 95.2%, respectively. In the multivariate analysis, the presence of acute rejection (p=0.014) and LUD (p=0.015) were significant prognostic factors for poor graft survival. Significantly superior growth in height after transplantation was observed in children transplanted at prepubertal age ( or =13 yrs). CONCLUSIONS: Long-term graft survival in pediatric renal transplantation can be obtained by aggressivemanagement of acute rejection, judicious surveillance for immunosuppression, and preferred selection of LRD. In addition, we recommend early renal transplantation in prepubertal children with ESRD on the basis of the significant posttransplant increment in height in prepubertal children.