Abstract
A226 Aims: The aim of the study is to evaluate our overall experience in pediatric renal transplantation and to determine the possible variables that may have an impact on graft survival. Methods: Between march 1976 and march 2003, 1518 live donor kidney transplant were carried out in our center, out of them 164 were 17 years old or less (mean age 13.1 years, ranging from 5 to 17 years). The commonest causes of ESRD were renal dysplasia (25%), nephrotic syndrome (22%), hereditary nephritis (20%), obstructive uropathy (18%) and primary oxalosis (6%). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analysis. Studied factors included age, sex, original kidney disease, HLA matching, pretransplant dialysis, iscemia time, number of renal arteries, primary urinary recontinuity, time to diuresis, occurrence of acute tubular necrosis, immunosuppressive regimen, rejection episodes, posttransplant hypertension. Results: Pretransplant blood transfusion was received by 60.4% of cases. Parents were the main source of donation (81%). Triple immunosuppression (prednisone + cyclosporine + azathioprine) was used in 70.8 % of transplants. Rejection free recipients constituted 45.5%. The graft survival at 1, 5 and 10 years were 92.5%, 71% and 40% respectively, while the patients‘ survival at 1, 5, and 10 years were 96%, 83.7% and 75 % respectively. The most common cause of graft failure was chronic rejection (67.3 %). Factors that had a significant impact on graft outcome by univariate analysis were: HLA mismatches, time to diuresis, occurrence of acute tubular necrosis, number of acute rejection and posttransplant hypertension. The multivariate analysis restricted the significance to rejection episodes and posttransplant hypertension. Conclusions: The independent predictors for graft survival in living related pediatric renal transplantation are acute rejection and posttransplant hypertension
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