PEDIATRIC RENAL TRANSPLANTATION: COMPARATIVE STUDY WITH RENAL TRANSPLANTATION IN THE ADULT POPULATION

Abstract

P365 Aims: To retrospectively review our experience with Pediatric renal transplantation and to compare the results with the Adult Population. Methods: Between January 1981 and August 2003, 1227 renal transplants were done in our Department. Seventy four patients ≤ 18 years at the time of the transplant were included in the Pediatric Group and compared with 1153 patients over 18 years included in the Adult Group. The actuarial kidney graft survival and patient survival were calculated by the Kaplan-Meier method and we analyzed various risk factors. Results: Median age was 13.8 ± 3.5 and 42.6 ± 2.4 years, respectively. There was no statistically significant difference in the HLA matching (2.3±0.95vs 2.4±1.0, P>0.05) or immunosuppression. There was however a lower donor age (26.0±10.1 vs 32.3±14.9 years, P<0.05) and shorter ischaemia time (17.9±8.1 vs 20.7 ± 6.6 hours, P<0.05) in the Pediatric Group. Overall, kidney transplant survival rates for patients ≤ 18 years at 1, 2, 5 and 10 years were 94.4%, 91.3%, 70.6% and 58.2% respectively, with no significant difference for patients older than 18 (91.2%, 89.3%, 78.8%, 60.5%, P=0.4325). Patients were further divided according to donor age (≤18; 19-59; ≥ 60 years) and cold ischaemia time of the graft (< 20; ≥ 20 hours). There was a significant graft survival decrease in the Adult Group at 10 years when the donor age was over 60 years (61.5 vs 37.7%, P<0.05) and when ischaemia time was ≥ 20 hours (63.6 vs 58.4%, P<0.05). In the Pediatric patients, there were no donor over 60 years and ischaemia time did not influence graft survival. The incidence of acute tubular necrosis (0.12±0.33 vs 0.17±0.38, P=0.19) and the creatinine levels of functioning grafts did not differ between the two groups. During the follow up (6.03±5.05 vs 5.96±4.53 years, P>0.05), acute rejections were more frequent in the younger group (0.49±0.50 vs 0.32±0.47, P<0.01). Patient survival in the Pediatric group at 1, 2, 5 and 10 years was 98.6%, 98,8%, 98.6% and 90.3%, respectively, significantly lower in the Adult group (95.3%, 94.0%, 87.9%, 76.8%, P<0.02). Conclusions: Renal transplantation may be successfully performed in the Pediatric patients with end stage renal disease. Although overall graft survival at 10 years did not differ significantly between the two groups, there is a decreased graft survival in the Adult patients when the donor age is over 60 years and cold ischaemia time is more than 20 hours. There is a higher incidence of acute rejections and longer patient survival in the Pediatric population.