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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.
Australian and New Zealand Journal of Medicine
|April 1, 1995
Summary
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.