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Updated: Aug 13, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Kidney transplantation in children younger than 1 year using cyclosporine immunosuppression
A Humar1, T E Nevins, M Remucal
1Department of Surgery, University of Minnesota, Minneapolis, USA.
Insights
Kidney transplants in children younger than 1 year old show comparable survival rates to older children. Transplant timing should prioritize renal function over age when a living donor is available.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
Background:
- End-stage renal disease (ESRD) in children presents unique challenges for treatment and management.
- Current pediatric ESRD treatment guidelines often recommend dialysis until a minimum age before considering kidney transplantation.
- Living donor (LD) kidney transplantation offers a potential alternative for very young children, but optimal timing remains debated.
Purpose of the Study:
- To evaluate the outcomes of primary living donor (LD) kidney transplantation in children younger than 13 years, focusing on age-specific comparisons.
- To determine if there is a minimum age restriction necessary for successful pediatric kidney transplantation.
- To assess the impact of early kidney transplantation on growth and development in infants and young children.
Main Methods:
- A retrospective analysis of 248 pediatric kidney transplants performed between 1984 and 1996 using cyclosporine immunosuppression.
- Recipients were stratified into three age groups: <1 year (n=26), 1-4 years (n=92), and 5-13 years (n=130).
- Primary LD transplants were specifically analyzed (n=25 for <1 year, n=59 for 1-4 years, n=58 for 5-13 years) to ensure comparable data.
Main Results:
- One- and 5-year patient and graft survival rates did not significantly differ among the age groups for primary LD transplants.
- All 25 infants (<1 year) survived with functional grafts, experiencing lower acute rejection rates but slightly higher delayed graft function incidence.
- Post-transplant growth, particularly weight, showed significant improvement in the youngest cohort, indicating positive developmental impact.
Conclusions:
- Pediatric kidney transplantation, including in infants under 1 year, yields outcomes comparable to those in older children.
- The decision for kidney transplantation timing in children should be guided by renal function and donor availability, not arbitrary age minimums.
- Living donor kidney transplantation is a viable and effective option for very young children with end-stage renal disease.
Objective:
The optimal age for transplantation in children with end-stage renal disease remains controversial. Supported by national data, many centers recommend dialysis until the child reaches a certain minimum age. The authors' policy, however, has been to encourage living donor (LD) transplants for young children, with no minimum age restriction.
Methods:
Between January 1, 1984, and December 31, 1996, the authors performed 248 kidney transplants in children younger than age 13 years, using cyclosporine as the primary immunosuppressive agent. Recipients were analyzed in three age groups: group 1, younger than age 1 year (n = 26); group 2, age 1 through 4 (n = 92); and group 3, age 5 through 13 (n = 130). Almost all recipients in group 1 underwent a primary LD transplant. Therefore, to compare results more meaningfully among the three age groups, only primary LD transplants were analyzed (group 1, n = 25; group 2, n = 59; group 3, n = 58).
Results:
In primary LD transplants, no significant difference was noted among the age groups in 1-and 5-year patient or graft survival rates. To date, all 25 recipients from group 1 are alive and well; 19 still have a functional original graft. Causes of graft loss in the remaining six recipients were chronic rejection (n = 3), vascular thrombosis (n = 2), and recurrent disease (n = 1). The incidence of acute rejection in group 1 recipients was lower than in the two older groups. However, the incidence of delayed graft function was slightly higher in the youngest group than in the two older groups. For recipients in group 1, growth (as measured by weight) improved significantly posttransplant: the mean standard deviation score rose from -2.8 pretransplant to -0.2 by age 5 and to +1.8 by age 10. The improvement in height was not as dramatic: the mean standard deviation score rose from -3.2 pretransplant to -1.6 by age 5 and to -1.4 by age 10.
Conclusions:
Kidney transplantation in young children, including those younger than 1 year old, can achieve results comparable to those in older children. As long as an adult LD is available, the timing of the transplant should be based on renal function rather than age.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management