25 YEARS OF PEDIATRIC DIALYSIS AND TRANSP LANTATION IN ZURICH

Between 1970 and 1994 84 children and adolescents with end stage renal failure (ESRF) were started on renal replacement therapy (RRT). Renal transplantation was the main goal from the beginning. The long term r esults were evaluated with emphasis on survival, development and socia l integration. RRT was started in nearly half of the children (45%) be tween the age of 10 and 15 years and in 14% before 5 years. 52 patient s were first treated by hemodialysis (HD) and 27 by peritoneal dialysi s (PD, since 1979). 5 patients underwent preemptive transplantation. B y December 1994, 75 patients had received 99 grafts, i.e. 75 1(st), 21 2(nd) and 3 3(rd) grafts; 3 kidneys were from living related donors a nd 8 patients were transplanted elsewhere. 7 patients were still on di alysis and 2 had died before transplantation. Actuarial patient surviv al (Kaplan-Meier) after start of RRT is 88% at 10 years and 75% at 17- 25 years. Actuarial patient survival after first transplantation incre ased from 91% (1970-1984) at 5 years to 97% (1985-1994). 7 of the firs t 10 patients transplanted from 1970-1974 are alive, all with function ing grafts (4 with their first graft). 9 patients died after transplan tation: 4 of recurrent disease, 2 of viral (CMV, EBV) infections and 1 each of spinalioma, allergic shock and traffic accident. First graft survival was 37% at 10 years. It increased from 53% (1970-1984) to 72% (1985-1994) at 5 years. The main causes of first graft loss (n = 33) were irreversible rejection (21) and recurrent disease (7). All patien ts aged >22 years were further evaluated: patients with start of RRT 1 970-1979 (group A, n = 18) were compared with those starting RRT from 1980-1987 (B, n = 19). Mean adult height in A was less than in B (163. 9 cm vs 168.5 cm in men; 146.3 cm vs 156.5 cm in women). 50% in A vs 3 2% in B had a disability. Fewer patients in A (39%) than in B (62%) we re fully employed. Considerably more patients in A (61%) than in B (37 %) lived with their parents or siblings although the mean age in A was 31 years vs 25 years in B. 3 women were married (all in B), 2 of them gave birth to 3 healthy children and the third was pregnant. Long ter m patient and graft survival, somatic development and social integrati on have improved over the years due to a variety of factors. A compreh ensive approach is necessary in treating children with ESRF.