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Updated: Jun 8, 2026
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Outcome of pediatric renal transplantation in north India
Aditi Sinha1, Pankaj Hari, Sandeep Guleria
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
Pediatric renal transplantation in New Delhi achieved excellent long-term graft and patient survival rates, demonstrating satisfactory outcomes despite resource limitations and high infection rates. This study highlights successful kidney transplant results in children.
Area of Science:
- Nephrology
- Pediatric Surgery
- Immunology
Background:
- Pediatric end-stage renal disease (ESRD) necessitates renal replacement therapy.
- Renal transplantation is a preferred treatment for pediatric ESRD, offering improved quality of life.
- Long-term outcomes data from resource-limited settings are crucial for guiding clinical practice.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric renal transplantation.
- To identify factors influencing graft survival and patient survival.
- To assess the spectrum of complications and morbidities post-transplantation.
Main Methods:
- Retrospective analysis of 45 renal transplants in 43 pediatric patients (1995-2008).
- Data collection included patient demographics, ESRD etiology, donor type, immunosuppression protocols, and complications.
- Graft and patient survival rates were calculated using Kaplan-Meier analysis.
Main Results:
- The primary causes of ESRD were reflux nephropathy and obstructive uropathy.
- Living related donors comprised the majority (91.1%) of donors.
- One-, five-, and 10-year graft survival rates were 91.1%, 80.4%, and 75.1%, respectively.
- One-, five-, and 10-year patient survival rates were 95.3%, 87.9%, and 76.9%, respectively.
- Acute rejection (AR) occurred in 31.1% and chronic rejection (CR) in 26.7% of allografts.
- Unsatisfactory compliance and multiple AR episodes predicted CR (p = 0.002).
- Common morbidities included urinary infections, CMV disease, and viral hepatitis.
- Graft loss occurred in 17.8% and mortality in 14% of patients.
Conclusions:
- Pediatric renal transplantation at a referral center in New Delhi yields highly satisfactory long-term outcomes.
- Despite challenges like resource scarcity and frequent infections, successful transplantation is achievable.
- Optimizing compliance and managing rejection episodes are critical for improving graft survival.
Abstract:
We report our experience and long-term outcome of pediatric renal transplantation at a referral center in New Delhi. During 1995-2008, 45 transplants were performed in 43 patients at a mean age of 13.3 ± 4.0 (range 3.8-18) yr. The chief causes for ESRD were reflux nephropathy, obstructive uropathy, vasculitis, renal dysplasia, and focal segmental glomerulosclerosis. Most (91.1%) donors were living related. Post-transplant immunosuppression comprised prednisolone, a calcineurin inhibitor and azathioprine or MMF. AR and CR were seen in 14 (31.1%) and 12 (26.7%) allografts, respectively. Predictors of CR were unsatisfactory compliance and multiple episodes of AR (p = 0.002 each). Urinary infections (n = 13), septicemia (4), tuberculosis (4), CMV disease (7), viral hepatitis (7), and pneumonia (3) were important causes of morbidity. Two patients each had lymphoproliferative disease and new-onset diabetes. There were eight (17.8%) graft losses and six (14%) deaths. The one-, five- and 10-yr graft survivals were 91.1%, 80.4% and 75.1%, respectively; the mean graft survival was 119.4 ± 8.38 months. The respective patient survivals were 95.3%, 87.9%, and 76.9% at one-, five- and 10 yr. Our results affirm that despite scarcity of resources and frequent infections, long-term outcomes of pediatric renal transplantation are highly satisfactory.
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