Kidney Transplantation in Infants

Abstract

After completing this article, readers should be able to: 1. Compare and contrast end-stage renal disease in children and adults. 2. Describe the anomalies that may accompany congenital urologic abnormalities. 3. List the primary causes of kidney graft losses in infants. 4. List the common infections encountered posttransplant. Kidney transplantation is the preferred mode of treatment for most children who have end-stage renal disease (ESRD). Despite advances in dialysis management, children who undergo this treatment modality experience stunting in growth and development,1 and mortality rates are higher for children on dialysis compared with those who receive transplants for all age groups.2 In the past, results of kidney transplantation in infants had made the procedure prohibitive, and success rates were extremely low. Compared with adults and larger pediatric patients, infants who have ESRD are at the highest risk for early graft loss and consistently have had the highest mortality rates. Recent advances in the medical and surgical management of these infants have led to improved results in survival and long-term renal transplant function. However, survival rates vary among transplant centers, and the infant subgroup remains the most challenging of any age group receiving transplantation. According to analyses of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) and the United Network of Organ Sharing (UNOS) data, 15% of living donor grafts and 35% of cadaver grafts in infants are lost in the early posttransplant period due to technical complications, vascular thrombosis, or irreversible acute rejection.33,4 Graft survival at 7 years for infants receiving transplantation from living donors (those in whom the best possible outcome is expected) is approximately 71% nationally,4 although results vary. This long-term graft survival is surprisingly high, considering that graft survival at 1 year was only 80% nationally. In our experience with 45 consecutive kidney transplants …