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Pediatric renal transplantation--the NAPRTCS experience
A H Tejani1, E K Sullivan, W E Harmon
1New York Medical College, Valhalla, New York, USA.
Clinical Transplants
|January 1, 1997
Summary
Pediatric kidney transplant recipients under 6 years old experience similar rejection rates but higher mortality. Younger children show better catch-up growth post-transplant, with improving graft survival rates over time.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Pediatrics
Background:
- The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database includes 4,329 children with renal transplants since 1987.
- Pediatric kidney transplant recipients differ from adults, with developmental disorders like renal dysplasia and focal segmental glomerulosclerosis being common causes of end-stage renal disease (ESRD).
- Preemptive transplantation, avoiding dialysis, is utilized in 24% of pediatric cases to mitigate growth issues.
Purpose of the Study:
- To analyze outcomes, including graft survival and growth, in pediatric kidney transplant recipients.
- To identify factors influencing graft survival and post-transplant growth in different pediatric age groups.
- To evaluate trends in graft survival for cadaver donor transplants over time.
Main Methods:
- Retrospective analysis of data from the NAPRTCS registry.
- Comparison of graft survival and rejection episodes across different age groups (infants, <6 years, >6 years).
- Assessment of growth (catch-up growth) and mortality rates post-transplantation.
Main Results:
- Children under 6 years have similar acute rejection rates but higher mortality and irreversible first rejection episodes. Infants (<2 years) show the highest mortality.
- Catch-up growth is more prevalent in younger children (47% <6 years vs. 22% >6 years).
- Five-year graft survival is 60% for cadaver donors and 76% for living donors, with significant improvements in cadaver donor graft survival since 1987 due to practice changes.
Conclusions:
- Younger pediatric kidney transplant recipients face higher mortality risks and unique challenges with graft failure. Preemptive transplantation does not guarantee accelerated growth.
- Age is a critical factor influencing post-transplant growth and survival outcomes in children. Continuous improvements in immunosuppression and donor selection enhance graft survival.
- The study highlights the evolving landscape of pediatric kidney transplantation, emphasizing the need for tailored management strategies based on age and underlying renal pathology.