Pediatric renal transplantation from living donors

Abstract

Purpose Renal transplantation (RT) from living-related donor (LRD) has important advantages regarding the improvement in transplant graft survival and the decreasing need of dialysis. Material and methods Of the last 166 renal transplants performed in our institution between 1994 and 2005, 44 (26.5%) were from LRD. We reviewed these 44 LRD, comparing the long-term results with cadaveric donors CD during the same period (50.5±33 months). All transplants were first grade living donors (17 fathers and 27 mothers). Mean age was 39.93±6.49 years old (26-50). Cold ischemic time was 1.8±0.52 hours. Primary renal disease was renal dysplasia (26.4%), nephropathy (13.2%), uropathy (30.9%), nephronoptisis (8.7%), glomerulopathy (6.6%) and others (11%). Mean age at renal transplant was 11.22 years (range 3.1-21.3). Twenty-two patients (50%) underwent transplantation before dialysis and 6 patients needed urinary tract reconstruction before surgery, and 22.7% were retransplants (second one in 8 patients, third in 1 case and fourth in 1 patient). Results Graft survival rates LD compared to CD was 97.6% vs 89% at one year, 89.4%-78% at 5 years and 80%-39% after 10 years. There were 4 graft loss due to rejection. Two patients died after 10 and 12 months of dialysis because of graft failure. Mean GFR was 84.5 ml/min/1.73 m (39.4-130 ml/min/m). Conclusions Renal transplantation from living-related-donors has a better long-term graft survival for first graft or even in retransplantion. RT from LRD must be the first choice of treatment for all patients with end stage renal disease.