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Renal transplantation in very young children
A Supabphol1, D M Francis, R J Millar
1University of Melbourne Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Insights
Renal transplantation in children under 5 with end-stage renal failure shows excellent patient survival. Live donor transplants are recommended for this age group, offering a viable treatment option.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
Background:
- Outcomes for renal transplantation in very young children with end-stage chronic renal failure are historically poor.
- This leads to under-treatment or reliance on chronic dialysis for affected children.
Purpose of the Study:
- To evaluate the efficacy and outcomes of renal transplantation in children under 5 years old.
- To advocate for live donor renal transplantation as a preferred treatment in this pediatric population.
Main Methods:
- A cohort of six children under 5 years received seven renal transplants between 1988 and 1992.
- Standard immunosuppression (cyclosporine, azathioprine, prednisolone) and an extraperitoneal approach were utilized.
- Intensive peri-operative monitoring and fluid management were implemented.
Main Results:
- 100% patient survival was achieved.
- One cadaver graft failure due to acute rejection occurred, with successful re-transplantation.
- Postoperative urinary fistulae in two children were successfully managed surgically.
Conclusions:
- Renal transplantation can be highly successful in very young children with end-stage chronic renal failure.
- Live donor renal transplantation should be considered the treatment of choice for this demographic.
- This study supports a revised approach to pediatric renal transplantation in this age group.
Abstract:
Results of renal transplantation in very young children with end-stage chronic renal failure have been poor compared with those in older children and adults. Consequently small children either may not be treated or may be placed on chronic dialysis programmes. Between 1988 and 1992, six children under the age of 5 years received seven renal transplants at the Royal Children's Hospital, Parkville, Victoria, Australia; five from live donors and two from cadaver donors. All children were treated with peritoneal dialysis before transplantation, and immunosuppressed with a standardized regimen of cyclosporine, azathioprine and prednisolone. An extraperitoneal incision was used, and the donor renal vessels were anastomosed to the lower abdominal aorta and inferior vena cava or the common iliac vein. All children received intensive monitoring and fluid replacement during the peri-operative period. Patient survival was 100%. One cadaver graft failed 1 week after transplantation because of irreversible acute rejection. This child subsequently received a successful second transplant. Two children developed postoperative urinary fistulae which were treated successfully by further operation. Current renal function in all children is excellent. The success of this programme has led us to review our attitude towards renal transplantation in this age group and to advocate live donor renal transplantation as the treatment of choice in very young children with end-stage chronic renal failure whenever possible.