Renal transplantation in children with emphasis on young patients

Abstract

We report the results of 41 consecutive renal transplantations performed on 39 children (median age 2.7 years). Twenty-six recipients were less than 5 years old. Twenty-one recipients (13 under the age of 5 years) received cadaver (CAD) grafts. All grafts except 2 were from adult donors and were placed extraperitoneally. Patients were on triple immunosuppression (cyclosporine plus azathioprine plus methylprednisolone). Mean follow-up time was 2.3 years. No vascular and only one ureteral complication was seen. Acute tubular necrosis occurred in 3 patients (7.3%). No grafts were lost due to acute rejection. Three-year patient survival and 1-year graft survival were 100%. The overall 3-year actuarial graft survival was 86%. Three-year survival of grafts from living-related donors (LRD) was 92% and that of CAD grafts 75%. In recipients younger than 5 years, 3-year LRD graft survival was '89% and CAD graft survival 73%. No significant differences in graft survival between recipients of different age groups or between LRD and CAD grafts were found. We conclude that results of renal transplantation in children under 5 years of age are comparable to those of older children, even using CAD grafts, when adult donors and triple immunosuppression are used.

Renal transplantation in children under 5 years of age

“…Patient survival in our center is comparable with others [6,8]. Laine et al [6] reported 100% patient survival at 3 years and Najarian et al [8] 97% at 1 and 3 years, and 95% at 5 years. However others have reported lessimpressive outcomes [7], particularly in infants [15].…”

“…It is usually followed by an improvement in growth [10] and psychomotor development [11]. Patient survival in our center is comparable with others [6,8]. Laine et al [6] reported 100% patient survival at 3 years and Najarian et al [8] 97% at 1 and 3 years, and 95% at 5 years.…”

“…4]. Nevertheless, there are recent reports of excellent results using both live-related donors (LRD) and cadaveric (CAD) grafts [6][7][8] and transplantation remains the preferred treatment for endstage renal failure (ESRF) in young children [7], offering the best potential for good quality of life [9], growth [10] and development [11]. We have reported previously our experience with CAD renal transplantation and mediumterm graft survival [12].…”

End-stage renal failure in children younger than 6 years: renal transplantation is the therapy of choice

“…Increased incidence of graft loss due to vascular thrombosis in younger children has been reported [9]. However, in recent years excellent results of renal transplantation have been reported in children under 5 [12,13,16]. In a large series from Minnesota, Najarian and coworkers [15] reported a 5-year graft survival rate using LRD of 73% in 75 infants under 2 years of age.…”

“…In contrast, the treatment of infants and young children remains controversial. Some authors reported excellent results with renal transplantation [12,16] whereas others discussed poor outcome after cadaveric donor (CAD) transplantation and increased incidence of graft vessel thrombosis [9].…”