Renal transplantation in children under 5 years of age

Between March 1987 and December 1997, 59 renal transplants [49 cadaveric, 10 live related (LRD)], were performed in 54 children aged 5 years and younger. Six children required a second transplant. The median (range) age of the recipients was 2.9 (1.4-5.0) years; mean weight was 12.6 kg (7.4-23) and donor age 11 (2-50) years. Immunosuppression was cyclosporin or FK506, prednisolone, and azathioprine. Antithymocyte globulin was given as induction therapy for second transplants. Patient survival was 98.3%; 1 patient died from upper gastrointestinal haemorrhage. Graft survival was 67.7% at 1 year, 57.4% at 5 years, and 45.2% at 10 years. No LRD graft was lost during 7 years of follow-up. Thrombosis was the main cause of graft loss (10 cases) followed by vascular rejection (2 cases). There was no significant difference in graft survival between recipients aged less than 2, 2-3, and 3-5 years. The height standard deviation score (+/-SD) improved from -2.1+/-1.3 at transplantation to -1.0+/-1.3 at 1 year, -1.1+/-1.5 at 5 years, and to -0.14+/-1.1 at 10 years.