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A single center experience with renal transplantation in young children
S E Lerner1, I Griefer, H C Taub
1Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467.
Insights
Pediatric renal transplantation in children under five is safe and effective. Early transplantation with living-related donors improves graft survival and promotes significant catch-up growth in young patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Growth and Development
Background:
- Pediatric renal transplantation outcomes have historically varied.
- Children under five with end-stage renal disease face significant growth challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of renal transplantation in very young children.
- To assess patient survival, allograft survival, and statural growth post-transplantation.
Main Methods:
- Retrospective review of 14 renal transplants in 13 children (13-50 months old) performed between 1983-1989.
- Analysis of patient and allograft survival, renal function, and serial height measurements.
- Calculation of growth velocity standard deviation scores.
Main Results:
- 100% patient survival and 100% allograft survival at 2-7.3 years for living-related donor recipients.
- 40% 1-year graft survival for cadaveric recipients.
- 9 out of 10 patients with good graft function showed improved height standard deviation scores, with 7 experiencing significant catch-up growth.
Conclusions:
- Renal transplantation is safe and effective in young children.
- Early transplantation, particularly with living-related donors, is optimal for preventing growth retardation.
- This intervention allows children with end-stage renal disease a chance at a normal life.
Abstract:
Results of pediatric renal transplantation have been variable. We evaluated our experience with renal transplantation in children less than 5 years old to determine its safety and efficacy. Of the 428 renal transplants done at our institution from August 1983 to December 1989, 14 were performed in 13 children 13 to 50 months old (mean age 34 months). All of the patients were small for age with height standard deviation scores ranging from -1.7 to -4.5. Patient survival, allograft survival and statural growth were used as determinants of successful outcome. Followup was complete in all patients, including renal function studies and serial height measurements. Growth velocity standard deviation scores were calculated. Patient survival was 100%. Allograft survival was 100% 2 to 7.3 years after transplantation for living related donor recipients whereas 1-year graft survival was poor (40%) for cadaveric graft recipients. Of 10 patients with good graft function at 1 year 9 demonstrated improvement in the height standard deviation score. Seven of 10 patients demonstrated significant catch-up growth (growth velocity standard deviation score greater than 0, p = 0.04). Our study supports the safety and efficacy of renal transplantation in young children. Early transplantation using living-related donor organs is the optimal therapy to prevent growth retardation and allow the young child with end stage renal disease to have a normal life.