Renal transplantation in children: results of 9 years of renal transplantation in children at our center

Abstract

ND-STAGE RENAL DISEASE (ESRL) in children is rare. The incidence ranges from one to three new cases yearly per million population. Chronic renal failure in childhood leads to growth retardation, osteodystrophy, and central nervous system morbidity. Renal transplantation (RTx) in children provides a degree of physical and psychological rehabilitation that is unmatched by any dialysis modality. In this article we record the results of RTx performed over a 9-year span on 41 children. PATIENTS AND METHODS From 1989 until 1996, 335 renal transplantations were performed in our center. Forty-one of these patients were children (6 to 18 years.). There were 22 male and 12 female children. The causes of renal failure were reflux nephropathy in eight children, neurogenic bladder in three children, posterior urethral valve in one child, prune belly syndrome in one child, and small kidney with unknown etiology in others. All kidneys were harvested from living donors; there were eight paternal donors, 12 maternal donors, six sibling donors, and 17 were unrelated. Immunosuppression therapy in all children were triple drugs, prednizolonazathioprine-cyclosporin. Acute rejection was treated by intravenous injection of methylprednisolone for 3 days. Antilymphocytic globuline (ALG) was applied for steroid resistance. In two children the grafts were placed intraperitoneally and the vessels were anastomosed to the aorta and vena cava, and in 39 children grafts were transplanted extraperitoneally in the pelvic region. To assess graft and patient survival we constructed the KaplanMeier curve and compared children and adult recipients in our center using the log-rank test. RESULTS Immediate diuresis occurred in all grafts. There were two end ureteral necroses and urinary leakages, which were repaired accordingly. Acute rejection occured in eight children but responded to pulse therapy. Chronic rejection was observed in 14 patients. In three other children, serum creatinine was 2.8 mg/100 mL. The function of grafts in other children was within normal range, and they have a good quality of life. The graft survival was: 2 years following Rtx, 93%; 80% after 5 years, and approximately 60% after 9 years. Patient survival was 100%. DISCUSSION