TEN YEARS OF PEDIATRIC RENAL TRANSPLANTATION

Abstract

We wish to report a 10 year experience with renal transplantation in children, aged 1-19 years, comparing consecutive 5 year intervals. Seventy six patients received 98 allografts during the period 1970-1980 with little substantive change in medical management. Thirty eight children received grafts from living related donors (LRD); and 60 cadaveric transplants(C) were done. Life table analyses were applied for statistical evaluation. During the period 1970-1974,5 year graft survival in the LRD group (n=21) was 43% and improved to 65% (n=17) during the subsequent 5 year period. From 1970-1974, 5 year survival in the C group (n=21) was 33% and increased to 47% (n=39) between 1975 and 1979. Ten year graft survival in the LRD group (n=38) is 53% compared with 43% graft survival in the C group (n=60). Most grafts that were lost ceased functioning early. Twenty nine percent (11/38) of LRD grafts and 35% (21/60) of C grafts were lost in the initial 3 months post-transplant. No LRD grafts were lost after 2 years except in one patient who had recurrence of focal segmental glomerulosclerosis 3.5 years post-transplant. Only one C graft was lost after 3 years. Patient survival was 95% (72/76). Results of our 10 year experience confirm that renal transplantation is a viable therapeutic modality in children. Our experience suggests if improvement in graft survival is to occur, factors in the perioperative period such as tissue typing, immunosupression, and the role of blood transfusions need further evaluation.