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Renal transplantation in young children
C P Burren1, C L Jones, D M Francis
1Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Vic.
Insights
Pediatric renal transplantation using triple immunosuppression achieved good patient and graft survival in young children. However, hypertension and impaired growth were common, with long-term outcomes still under investigation.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Pediatrics
Background:
- Renal transplantation in children under five years old presents unique challenges.
- Optimizing immunosuppression is crucial for graft survival and patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of renal transplantation in very young children.
- To assess the efficacy and safety of triple immunosuppression (cyclosporin A, azathioprine, prednisolone).
Main Methods:
- Retrospective review of medical records for children under five undergoing renal transplantation since 1988.
- Follow-up duration of 30 months (range 18-36 months).
Main Results:
- Seven renal allografts were performed in six children (median age 3.75 years).
- One cadaveric graft was lost due to acute rejection; no patient deaths occurred.
- All recipients developed hypertension; all required prednisolone, and experienced side effects from cyclosporin A (hirsutism, gingival hyperplasia, nephrotoxicity).
- Growth was significantly impaired (median height SDS -1.90 at 30 months).
Conclusions:
- Triple immunosuppression provides satisfactory patient and graft survival in this young pediatric cohort.
- Hypertension and poor skeletal growth are significant long-term concerns.
- Further studies are needed to determine the long-term renal function with this immunosuppressive regimen.
Aims:
To review the outcome of renal transplantation in small children treated with triple immunosuppression at a single Australian centre.
Methods:
The medical records of all children under the age of five years undergoing renal transplantation from 1988 were reviewed. The duration of follow-up was 30 months (range 18-36).
Results:
Six children received seven renal allografts (five living-related [LR] and two cadaveric [CD]). They had a median age of 3.75 years (range 1.5-4.9) and weight of 11.6 kg (9.1-14.5) at the time of transplantation. All patients received an immunosuppressive regime involving cyclosporin A, azathioprine and prednisolone. There were no deaths. The only graft lost was a CD graft (severe acute rejection within one week of transplantation). Hypertension occurred in all recipients and usually required more than one antihypertensive drug for treatment. Renal function measured by serum median creatinine concentration (range) was 0.05 mmol/L (0.03-0.11) at three months (n = 6) and 0.10 mmol/L (0.07-0.22) at 30 months (n = 4). Growth estimated from median (range) height standard deviation scores was -1.97 (-1.36-(-4.04)) at three months (n = 6) and -1.90 (-1.74-2.50) at 30 months (n = 4). No patient was entirely weaned from prednisolone. Cyclosporin A side effects included hirsutism (five patients), gingival hyperplasia (six patients) and nephrotoxicity (three patients).
Conclusions:
Satisfactory patient and graft survival can be accomplished in this recipient age group. The results compare with other international experience and accumulating Australian experience. Hypertension and poor skeletal growth were consistent observations. The long-term outcome of renal function using triple immunosuppression remains to be determined.