Renal Transplantation in the Infant and Young Child

Kalia, Alok

doi:10.1001/archpedi.1988.02150010057021

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…Our current immunosuppressive protocol is similar to what other centers use for infants and young children after kidney transplants (19–22). The Stanford group now routinely uses humanized monoclonal antibody (daclizumab) induction in place of conventional anti‐T‐cell antibodies (23).…”

Section: Discussionmentioning

confidence: 99%

Kidney transplants for children under 1 year of age – a single‐center experience

Khwaja

Humar

Najarían

2003

Pediatric Transplantation

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From September 20, 1970 to October 24, 2001, we performed 46 kidney transplants in infants under 1 yr old at the University of Minnesota. This article reviews the preoperative care, surgical technique, and immunosuppression. Recipients included 16 females and 30 males; the youngest recipient was 6 wk old. The mean pretransplant height was 62.8 cm, which increased to 77 cm at 1 yr post-transplant and to 104 cm at 5 yr. We used 40 living donors (all but 1 were related to the recipient) and 6 cadaver donors. The overall actuarial graft survival was 85% at 1 yr and 70% at 5 yr. In the cyclosporine era, graft survival improved to 91% at 1 yr and 80% at 5 yr. Death with function was the most common cause of graft loss (n = 5), followed by biopsy-proven chronic rejection (n = 4), biopsy-proven recurrent disease (n = 3), and graft thrombosis (n = 2). Patient survival was 91% at 1 yr and 86% at 5 yr. In the cyclosporine era, patient survival was 100% at 5 yr and 85% at 10 yr. We concluded that an early transplant is the best treatment option for infants under 1 yr old with chronic renal failure. Whenever possible, adult living kidney donors should be used.

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Section: Discussionmentioning

confidence: 99%

Kidney transplants for children under 1 year of age – a single‐center experience

Khwaja

Humar

Najarían

2003

Pediatric Transplantation

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Successful renal transplantation in children under 6 years of age

Dall’Amico¹,

Ginevri

Ghio

et al. 2001

Pediatric Nephrology

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To evaluate the efficacy of renal transplantation in small pediatric patients, we have reviewed 41 allografts performed in 39 children (28 M/11 F) less than 6 years of age between 1987 and 1998 in the North Italy Transplant Program. Of these patients, 39 had a cadaver donor and 2 a living-related donor, with ages ranging from 20 days to 35 years. The mean follow-up was 56 months. Graft survival was 74.5% and 70.5% at 1 and 5 years, respectively. The causes of graft lost were acute rejection (4), graft vascular thrombosis (4), and hemolytic uremic syndrome recurrence (1). Only 1 patient has died due to chickenpox. Double and triple immunosuppressive therapies were used in 63% and 37% of patients, respectively, on the basis of different center protocols, without differences in graft survival. Steroids were successfully administered on alternate days in 37% of patients, 6-12 months after transplantation. Thrombosis was reported in 2 of 6 kidneys from donors less than 1 year of age and in 2 of 35 donors older than 1 year (P<0.05). Thirty rejections occurred in 23 patients: 7 episodes were steroid resistant and were treated with ATG/OKT3. Thirty-four infections were reported in 16 of 41 patients; of these 17 were viral, 14 bacterial, and 3 due to Mycoplasma. Four surgical complications were reported: 1 graft artery stenosis, 1 ureteral stenosis, 1 urinary leak, and 1 lymphocele. Mean height standard deviation score improved from -2.0±1.3 pre transplantation to -1.8±1.4, -1.5±1.3, and -1.5±1.5 at 1, 2, and 5 years post transplantation. Linear growth was significantly better in infants treated with alternate-day steroids. Hypertension was a frequent complication, since 19 of the 30 patients with a 5-year follow-up were still being treated with antihypertensive drugs. In conclusion, graft survival in patients less than 6 years old is satisfactory and similar to that obtained in children aged from 6 to 18 years (70.5% vs. 78.9% at 5 years, P=NS). Consequently, since there are many difficulties in managing infants on maintenance dialysis, an early transplant should be considered. Donors older than 24 months carry a low risk of vascular thrombosis and may be successfully grafted in infants.

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Renal Transplantation in the Infant and Young Child

Cited by 2 publications

References 25 publications

Kidney transplants for children under 1 year of age – a single‐center experience

Kidney transplants for children under 1 year of age – a single‐center experience

Successful renal transplantation in children under 6 years of age

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