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 followup 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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Najarian JS, Frey DJ, Matas AJ, Gillingham KI, So SKS, Cook M, Chavers B, Mauer SM, Nevins TE (1990) Renal transplantation in infants. Ann Surg 212: 353–367
Ettenger RB, Rosenthal JT, Marik J, Malekzadeh MH, Forsythe SB, Kamil ES, Salusky IB, Fine RM (1991) Improved cadaveric renal transplant outcome in children. Pediatr Nephrol 5: 137–142
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: 1727–1732
Fitzpatrick MM, Duffy PG, Fernando ON, Barratt TM, Dillon MJ, Trompeter RS (1992) Cadaveric renal transplantation in children under 5 years of age. Pediatr Nephrol 6: 166–171
Briscoe DM, Kim MS, Lillehei C, Eraklis AJ, Levey RH, Harmon WE (1992) Outcome of renal transplantation in children less than two years of age. Kidney Int 42: 657–662
Antikainen M, Holmberg C, Taskinen M-R (1992) Growth, serum lipoproteins and apoproteins in infants with congenital nephrosis. Clin Nephrol 38: 254–263
Holmberg C, Jalanko H, Koskimies O, Leijala M, Salmela K, Eklund B, Ahonen J (1991) Renal transplantation in small children with congenital nephrotic syndrome of the Finnish type. Transplant Proc 23: 1378–1379
Hoppu K, Koskimies O, Holmberg C, Hirvisalo EL (1991) Pharmacokinetically determined cyclosporin dosage in young children. Pediatr Nephrol 5: 1–4
Hoppu K, Koskimies O, Holmberg C, Hirvisalo EL (1991) Evidence for pre-hepatic metabolism of oral cyclosporine in children. Br J Clin Pharmacol 32: 477–481
Lautenschlager I, Suni J, Ahonen J, Grönhagen-Riska C, Räisänen S, Tukiainen P (1988) Rapid diagnosis of cytomegalovirus infection in renal transplant recipients. Transplant Proc 20: 408–409
Hughes WT, Rivera GK, Schell MJ, Thornton D, Lett L (1987) Successful intermittent chemoprophylaxis forPneumocystic carinii pneumonitis. N Engl J Med 316: 1627–1635
Häyry P, Willebrand E von, Ahonen J, Eklund B, Lautenschlager I (1981) Monitoring of organ allograft rejection by transplant aspiration cytology. Ann Clin Res 13: 264–287
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate derived from body length and plasma creatinine. Pediatrics 58: 259–263
Cutler SJ, Ederer F (1958) Maximum utilization of the life table method in analyzing survival. J Chron Dis 8: 699–712
Sorva R, Tolppanen EM, Lankinen S, Perheentupa J (1985) Evaluation of childhood growth. Duodecim 101: 465–476
Broyer M, on behalf of the EDTA Registry Committee (1989) Kidney transplantation in children — data from the EDTA registry. Transplant Proc 21: 1985–1988
Ettenger RB, Rosenthal JT, Marik J, Salusky IB, Kamil E, Malekzadeh MH, Fine RM (1989) Successful cadaveric renal transplantation in infants and young children. Transplant Proc 21: 1707–1708
Yuge J, Cecka JM (1992) Sex and age effects in renal transplantation. In Terasaki PI, Cecka JM (eds) Clinical transplants 1991. UCLA Tissue Typing Laboratory, Los Angeles, pp 257–267
Harmon WE, Stablein D, Alexander SR, Tejani A (1991) Graft thrombosis in pediatric renal transplant recipients. Transplantation 51: 406–412
Cicciarelli J, Cho Y (1992) HLA matching: univariate and multivariate analyses of UNOS Registry data. In Terasaki PI, Cecka JM (eds) Clinical transplants 1991. UCLA Tissue Typing Laboratory. Los Angeles, pp 325–333
Ahmed Z, Terasaki PI (1992) Effect of transfusions. In Terasaki PI, Cecka JM (eds) Clinical transplants 1991. UCLA Tissue Typing Laboratory, Los Angeles, pp 305–312
Mahan JD, Mauer M, Sibley RK, Vernier RL (1984) Congenital nephrotic syndrome: evolution of medical management and results of renal transplantation. J Pediatr 105: 549–557
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Laine, J., Holmberg, C., Salmela, K. et al. Renal transplantation in children with emphasis on young patients. Pediatr Nephrol 8, 313–319 (1994). https://doi.org/10.1007/BF00866346
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00866346