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Long-term outcome of one haploidentical live related donor transplantation in children
E Ingulli1, R Gonzalez, D Rajpoot
1Renal Division, Children's Medical Center, Brooklyn, N.Y.
Insights
Pediatric kidney transplant recipients showed excellent long-term survival rates. Ciclosporin A (CSA) and prednisone therapy improved graft survival compared to azathioprine and prednisone, with no significant impact on growth.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Immunosuppression
Background:
- Pediatric kidney transplantation is a vital treatment for end-stage renal disease.
- Long-term outcomes and optimal immunosuppressive strategies require ongoing investigation.
Purpose of the Study:
- To evaluate long-term patient and graft survival in children undergoing one-haploidentical live related donor kidney transplantation.
- To compare the efficacy of different post-transplant immunosuppressive regimens, specifically azathioprine/prednisone versus ciclosporin A (CSA)/prednisone.
Main Methods:
- Retrospective analysis of 69 pediatric kidney transplant recipients (6 months to 18 years) between 1972 and 1989.
- Comparison of patient and graft survival rates based on donor type, recipient ethnicity, original diagnosis, and immunosuppressive therapy.
- Assessment of growth and growth hormone levels in patients receiving CSA/prednisone therapy.
Main Results:
- Excellent 5- and 10-year actuarial patient survival (84%) and graft survival (70% and 41%, respectively).
- Paternal recipients demonstrated better graft survival than maternal recipients (p<0.05).
- CSA/prednisone regimen showed superior 5-year actuarial graft survival (76%) compared to azathioprine/prednisone (57%) (p<0.03).
- No significant differences in graft survival were observed among different ethnic groups.
- Recurrence of original disease was low (1/16 FSGS, 1/7 lupus nephritis).
- CSA/prednisone therapy allowed for prednisone discontinuation in 16 patients, with adequate growth hormone levels and accelerated growth in younger children.
Conclusions:
- One-haploidentical live related donor kidney transplantation offers favorable long-term outcomes in children.
- Ciclosporin A (CSA) and prednisone is a more effective immunosuppressive regimen than azathioprine and prednisone, leading to improved graft survival.
- CSA/prednisone therapy does not adversely affect growth in pediatric kidney transplant recipients and may even promote accelerated growth in younger children.
Unlabelled:
We report on 69 children, 6 months to 18 years old, who received a one-haploidentical live related donor transplantation from 11/72 through 4/89. Thirty patients were maternal and 22 were paternal recipients; 23 were Black, 27 Caucasian, 17 Hispanic, and 1 each Oriental and Arabic. The original diagnoses in these patients were aplastic/dysplastic kidneys 13%, obstructive uropathy 30%, focal segmental glomerulosclerosis (FSGS) 23% and lupus nephritis 10%.
Results:
1-, 5-, 10- and 15-year actuarial patient and graft survivals were 98, 84, 84, 84% and 94, 70, 41, 30% respectively. Actual 5-year graft survival of paternal recipients was better than maternal recipients (p less than 0.05). No differences were noted comparing actuarial graft survival between Blacks, Caucasians and Hispanics. 1/16 FSGS and 1/7 lupus nephritis patients had recurrence of their original disease. Posttransplant therapy in 37 patients consisted of azathioprine and prednisone while 32 patients received ciclosporin A (CSA) and prednisone. At transplantation, CSA and prednisone patients were younger, i.e., 10.7 years (range 0.5-18) compared to 13.3 years (range 4-18) and (p less than 0.03) in azathioprine and prednisone patients. The 5-year actuarial graft survival of azathioprine and prednisone patients was 57% compared to 76% in CSA and prednisone patients. 16/32 CSA and prednisone patients had their prednisone discontinued for a mean duration of 18 months (3-54 months). Ten of these 16 patients were prepubertal and had their growth hormone levels measured. All had an adequate level (greater than or equal to 10 ng/ml) poststimulation. Five of the 10 patients were less than 6 years of age and exhibited accelerated growth.(ABSTRACT TRUNCATED AT 250 WORDS)