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Outcome of renal transplantation in children aged 1-5 and 6-18 years
H E Leichter1, K J Sheth, M J Gerlach
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226.
Insights
Pediatric renal transplantation outcomes are improving for young children. Newer immunosuppressive regimens show comparable graft survival rates to older children, making kidney transplants a viable option for younger patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Immunosuppression Therapy
Background:
- Historically, renal transplantation outcomes in younger children were suboptimal.
- Advancements in immunosuppressive therapies may improve results in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of modern immunosuppressive regimens on renal transplant outcomes in very young children.
- To compare outcomes between a cohort of very young pediatric kidney transplant recipients and older pediatric recipients.
Main Methods:
- Retrospective analysis of 5 children (aged 1.6-5.0 years) undergoing renal transplantation.
- Comparison with 10 older pediatric patients (aged 6.0-18.5 years).
- Standard immunosuppression protocols including prednisone, azathioprine, and ciclosporin for cadaveric transplants were used.
Main Results:
- Rejection episodes and side effects were similar between younger and older pediatric groups.
- Graft survival was comparable, with one death in the younger group due to a non-transplant-related issue.
- Improved growth and development were observed in the younger cohort post-transplantation.
Conclusions:
- Renal transplantation is a feasible and effective option for very young pediatric patients.
- Modern immunosuppression strategies yield comparable graft survival rates to older pediatric recipients.
- Kidney transplantation offers significant benefits for growth and development in young children.
Abstract:
Results of renal transplantation in younger children have not been very encouraging in the past. We therefore studied the effect of newer immunosuppressive regimens on the outcome of renal transplantation of 5 children aged 2.9 +/- 1.3 years (range 1.6-5.0), and compared it to 10 children of an older pediatric patient group aged 11.4 +/- 4.4 years (range 6.0-18.5). All patients with the exception of 1 underwent dialysis. The percentage of cadaveric and live-related transplants was similar in both groups. Recipients of a cadaveric transplant had at least 3 blood transfusions; recipients of live-related transplants had donor-specific transfusions with azathioprine. Posttransplantation immunosuppression consisted of prednisone and azathioprine; recipients of cadaveric transplants received also ciclosporin. Rejection episodes and side effects (hypertension, hirsutism) were comparable in both groups. In the younger patient group, 1 patient died of a congenital lung abnormality but had a functioning graft. In the older patient group, 1 patient lost his graft 16 months posttransplantation due to reduction of his immunosuppressives, necessitated by a severe CMV infection. Growth and development improved in the younger patient group, but was stable in older patients. Renal transplantation is a suitable option in younger pediatric patients. Graft survival rates are comparable to those of older patients.