Renal transplantation in very young children

Thirteen cadaver and three live-donor renal transplants were undertaken in fifteen children aged less than 5 years, of whom seven were younger than 3 years. Mean weight of the recipients was 11.5 kg; six weighted less than 10 kg at operation. Mean age of the cadaver donors was 13.5 years. Bilateral nephrectomy was undertaken before or at the time of transplantation in eight recipients; ten required dialysis before transplantation. Five grafts were lost in four patients, three owing to long-segment renal-artery stenosis possibly due to chronic rejection. After mean follow-up of 1.2 years the mean plasma creatinine of the ten functioning grafts was 64 mumol/l with a mean estimated glomerular filtration rate of 70 ml/min/1.73 m2. Careful circulatory control to avoid hypovolaemia or hypervolaemia and the maintenance of a high urine flow rate immediately post-transplant have prevented the graft loss due to thromboses or primary non-function previously reported with cadaver grafts in young children. Postoperative growth has been encouraging.