Renal transplantation in 1-5 year olds

Garcia, et al reported their experience with renal transplantation in 38 children (40 transplant), ages 1-5 years over a 16 year period.

Demographics as well as patient and graft survivals were all reported. The mean age at transplantation was 3.3 ± 1.3 years and the mean weight was 14 kilograms with a range of 5.7-25 kg. The population consisted of 92.5% Caucasian, 7.5% African Brazilian. The main etiology for end-stage renal disease was uropathic/vesicoureteral reflux in 45% of the children followed by glomerulopathy in 25%, congenital/hereditary disease in 10% and hemolytic uremic syndrome at 12.5%. Prior to transplantation, 5% were on hemodialysis, 85% on peritoneal dialysis, and 10% were preemptive transplants.

All the children were followed for at least 6 months posttransplantation, except 2 who died in the first month. In 75% of the cases, kidneys were obtained from living-related donors, an in 25% they were cadaveric. Thirty-nine kidneys were placed extraperitoneal. The primary immunosuppressant therapy consisted of cyclosporine in 61% of the patients, tacrolimus in 39%, mycophenolate in 49% and azathioprine in 51%. A steroid-free protocol was used in 17% of the patients. In the last 21 cases, basiliximab or daclizumab was added.

The group found that there were 13 (32.5%) graft losses. Four of these had artery/vein thromboses, 3 chronic rejections, 3 deaths, and 3 were other causes. The 5-year patient and graft survival rates were 89.6% and 72.2%, respectively. With this information, the group concluded that renal transplantation can be performed with good long term results in children younger than 6 years of age.

C.D. Garcia, V.B. Bittencourt, F. Pires, E. Didone, E. Guerra, S.P. Vitola, J. Antonella, D. Malheiros, A. Tumelero, V.D. Garcia.

Transplantation Proceedings 39(2): 373-375, March 2007

By Pasquale Casale, MD

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