At our institution, 521 kidney transplants were performed in 429 children (mean age 8.7±5.6-years) between 1969 and 1991. Of these transplants, 408 were primary, 113 were retransplants, 347 were living related, 171 were cadaver, and 3 were living nonrelated. Immunosuppression consisted of prednisone, azathioprine, and Minnesota antilymphocyte globulin (non-CSA) in 339 patients, total lymphoid irradiation in 8, and, more recently, cyclosporine (CSA) in addition in 168 patients. Average followup was 8.8±6.0 years.
Actuarial graft survival in the non-CSA versus CSA groups at 1 year was 77.0% versus 85.7%; at 5 years, 59.6% versus 71.9%. Of 136 non-CSA patients, causes of graft loss at 5 years included: chronic rejection in 55 (40.4%), acute rejection in 27 (19.9%), recurrent disease in 16 (11.8%), technical complications in 8 (5.9%), infectious complications in 4 (2.9%), other causes in 5 (3.7%), and death with a functioning graft in 21 (15.4%). Of 40 CSA patients, causes of graft loss at 5 years included: chronic rejection in 16 (40.0%), acute rejection in 8 (20.0%), recurrent disease in 6 (15.0%), technical complications in 3 (7.5%), other causes in 2 (5.0%), and death with a functioning graft in 5 (12.5%).
The causes of graft loss did not significantly differ in the non-CSA and CSA groups. Chronic rejection was the most common cause of graft loss in both groups. Research focusing on chronic rejection is needed to improve graft outcome in pediatric kidney transplantation.
Allograft loss Causes Large single-center pediatric population
This is a preview of subscription content, log in to check access.
Ettenger R, Marik J, Rosenthal JT (1992) Sequential therapy in pediatric cadaveric renal transplantation: a critical analysis. J Am Soc Nephrol 2 [Suppl 3]: S304–S311PubMedGoogle Scholar
McEnery PT, Stablein DM (1992) Does human lymphocyte antigen matching improve the outcome in pediatric renal transplants? J Am Soc Nephrol 2 [Suppl 3]: S234–S237PubMedGoogle Scholar
Nevins TE, Dunn DL (1992) Use of ganciclovir for cytomegalovirus infection. J Am Soc Nephrol 2 [Suppl 3]: S270–S273PubMedGoogle Scholar
Miller LC, Bock GH, Lum CT, Najarian AJS, Mauer SM (1982) Transplantation of the adult kidney into the very small child: longterm outcome. J Pediatr 100: 675–680PubMedGoogle Scholar
Matas AJ, Sibley R, Mauer SM, Sutherland DER, Simmons RL, Najarian JS (1983) The value of needle renal allograft biopsy. A retrospective study of biopsies performed during putative rejection episodes. Ann Surg 197: 226–237PubMedGoogle Scholar
Gehan E (1965) A generalized Wilcoxon test for comparing arbitrarily singly-censored samples. Biometrika 52: 203–223PubMedGoogle Scholar
Offner G, Hoyer PF, Brodehl J, Pichlmayr R (1987) Cyclosporine A in pediatric kidney transplantation. Pediatr Nephrol 1: 125–130PubMedGoogle Scholar
Alexander SR, Arbus GS, Butt KMH, Conley S, Fine RN, Greifer I, Gruskin AB, Harmon WE, McEnery PT, Nevins TE, Nogueira N, Salvatierra O Jr, Tejani A (1990) The 1989 report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 4: 542–553PubMedGoogle Scholar
Ettenger RB, Rosenthal JT, Marik J, Nelson P, Malekzadeh M, Grimm PC, Kamil ES, Salusky IB, Fine RN (1990) Cadaver renal transplantation in children: results with long-term cyclosporine immunosuppression. Clin Transplant 4: 329–336Google Scholar
Schweitzer EJ, Matas AJ, Gillingham KJ, Payne WD, Gores PF, Dunn DL, Sutherland DER, Najarian JS (1991) Causes of renal allograft loss: progress in the 1980s, challenges for the 1990s. Ann Surg 214: 679–688PubMedGoogle Scholar
Gruber SA, Chavers B, Skjei KL, Sothern RB, Robison L, Tzardis P, Moss A, Gillingham K, Canafax DM, Najarian JS, Matas AJ, Dun DL (1991) De novo cancer after pediatric kidney transplantation. Transplant Proc 23: 1373–1374Google Scholar
Penn I (1991) Occurrence of cancers in immunosuppressed organ transplant recipients. In: Terasaki P (ed) Clinical transplants 1990. UCLA Tissue Typing Laboratory, Los Angeles, pp 53–62Google Scholar
Melosky B, Karim M, Chui A, McBride M, Cameron EC, Yeung CK, Landsberg D, Shackleton C, Keown PA (1992) Lymphoproliferative disorders after renal transplantation in patients receiving triple or quadruple immunosuppression. J Am Soc Nephrol 2: S290–S294PubMedGoogle Scholar
Broyer M, on behalf of the, European Dialysis and Transplant Association Registry Committee (1989) Kidney transplantation in children — data from the EDTA Registry. Transplant Proc 21: 1985–1988PubMedGoogle Scholar
Broyer M, Selwool N, Brunner F (1992) Recurrence of primary renal disease on kidney graft: a European pediatric experience. J Am Soc Nephrol 2: S255–S257PubMedGoogle Scholar
McEnery PT, Stablein DM, Arbus G, Tejani A (1992) Renal transplantation in children. A report of the North American Pediatric Renal Transplant Cooperative Study. N Engl J Med 326: 1727–1732PubMedGoogle Scholar
Stephanian E, Matas AJ, Mauer SM, Chavers B, Nevins T, Kashtan C, Sutherland DER, Gores P, Najarian JS (1992) Recurrence of disease in patients retransplanted for focal segmental glomerulosclerosis. Transplantation 53: 755–757PubMedGoogle Scholar
Striegel JE, Sibley RK, Fryd DS, Mauer SM (1986) Recurrence of focal segmental glomerulosclerosis in children following renal transplantation. Kidney Int 30: S44–S50Google Scholar
Senggutuvan P, Cameron JS, Hartley RB, Rigden S, Chantler C, Haycock G, Williams DG, Ogg C, Koffman G (1990) Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol 4: 21–28PubMedGoogle Scholar
Ingulli E, Tejani A (1991) Incidence, treatment, and outcome of recurrent focal segmental glomerulosclerosis posttransplantation in 42 allografts in children — a single-center experience. Transplantation 51: 401–405PubMedGoogle Scholar
Jones RM, Murie JA, Ting A, Dunnill MS, Morris PJ (1988) Renal vascular thrombosis of cadaveric renal allografts in patients receiving cyclosporin, azathioprine and prednisolone triple therapy. Clin Transplant 2: 122–126Google Scholar
Gruber SA, Chavers B, Payne WD, Fryd DS, Canafax DM, Simmons RL, Najarian JS, Matas A (1989) Allograft renal vascular thrombosis — lack of increase with cyclosporine immunosuppression. Transplantation 47: 475–478PubMedGoogle Scholar
Harmon WE, Stablein D, Alexander SR, Tejani A (1991) Graft thrombosis in pediatric renal transplant recipients. A report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 51: 406–412PubMedGoogle Scholar
Myers BD, Sibley R, Newton L, Tomlanovich SJ, Boshkos C, Stinson E, Luetscher JA, Whitney DJ, Krasny D, Coplon NS, Perlroth MG (1988) The long-term course of cyclosporine-associated chronic nephropathy. Kidney Int 333: 590–600Google Scholar
Ettenger RB, Blifeld C, Prince H, Gradus DB, Cho S, Sekiya N, Salusky IB, Fine RN (1987) The pediatric nephrologist's dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr 111: 1022–1025PubMedGoogle Scholar
Offner G, Hoyer PF, Juppner H, Krohn HP, Brodehl J (1987) Somatic growth after kidney transplantation. Beneficial effect of cyclosporine in comparison with conventional immunosuppression. Am J Dis Child 141: 541–546PubMedGoogle Scholar
So SKS, Chang PN, Najarian JS, Mauer SM, Simmons RL, Nevins TE (1987) Growth and development in infants after renal transplantation. J Pediatr 110: 343–350PubMedGoogle Scholar
Bosque M, Munian A, Bewick M, Haycock G, Chantler C (1983) Growth after renal transplants. Arch Dis Child 58: 110–114PubMedGoogle Scholar