Renal Transplantation in Children Less Than Two Years Old1

Abstract

Twenty-one infants, 2 years old or younger, received 21 renal transplants between 1983 and 1995. Six of the transplantations were performed from 1983 to 1989, and the remaining 15 were performed from 1990 to 1995. The median age at transplantation was 16.0 months and the median body weight was 9.0 kg. Living-related donor kidneys were used in 15 cases, an adult cadaveric donor kidney was used in one case, and pediatric cadaveric donor kidneys were used in five cases. All grafts were placed intra-abdominally. The immunosuppressive therapy consisted of cyclosporine, azathioprine, and prednisolone. No prophylactic antithymocyte globulins were used. Five infants have died, one with a functioning graft and four after loss of graft function. All graft losses and deaths occurred during the first 6 months after transplantation. The 5-year patient survival and graft survival rates were 87% for recipients of living donor grafts and 44% for recipients of cadaveric grafts. The median height SD score increased from -3.7 before operation to -1.9 at 1 year, -0.7 at 3 years, and -1.1 at 5 years. The glomerular filtration rate in absolute values remained stable in all infants, whereas a reduction in glomerular filtration rate related to body surface area was seen at follow-up, 5 years after transplantation. We conclude that renal transplantation can be performed with good long-term results in children less than 2 years old.

Growth after renal transplantation in infancy or early childhood

“…Many centers have reported catch-up growth after TX in children <5 years of age [22][23][24][25], and this is supported by our findings. It is also in agreement with the large NAPRTCS (North American Pediatric Renal Transplant Cooperative Study) registry report, in which catch-up growth after TX was seen primarily in the youngest age groups [26].…”

“…In many earlier reports, "catchdown" growth was seen a few years after TX. Although not reported in detail, it seems to be related to deterioration of graft function with time [25,30]. As we and other authors have shown, the youngest recipients receiving an adult graft do not maintain their long-term graft function in response to body growth [15,16,25].…”

“…3 Relation between glomerular filtration rate 5 years after TX and subsequent growth velocity from 5 to 7 years after TX in 17 children <5 years of age at TX and without recombinant human growth hormone (r Pearson's correlation coefficient) Height deficit at the time of TX has been shown to correlate with height increment following TX [6]. However, hSDS at TX has been clearly lower in many earlier reports than in our children and has ranged from -2.1 to -3.7 [22][23][24][25]. The very youngest recipients have usually had the greatest growth deficit at TX.…”

Renal Transplantation in Small Children &ndash; A Comparison between Surgical Procedures

“…It is evident that small patients benefit with respect to their mental and physical development. Lerner et al [1], for example showed that early kidney transplantation can prevent growth retardation [1, 2, 3, 4, 5]. Living donor transplantation should be performed whenever a suitable donor is available, especially for children with a severe underlying disease, e.g.…”

“…In many cases, a successful renal transplantation results in the normal mental and physical development of a child. Thus, even very young children with end–stage renal failure are being referred for consideration of a renal transplant [1, 2, 3, 4, 5, 6]. From the surgical point of view, small children remain a problematic patient group as the discrepancy between graft and recipient vessels may lead to various surgical complications.…”