IMPACT OF AGE ON RENAL GRAFT-SURVIVAL IN CHILDREN AFTER THE FIRST REJECTION EPISODE

Infants are thought to be more immunoreactive and at a greater risk fo r developing irreversible rejection compared with older children. We i nvestigated this by analyzing patient and graft survival rates, incide nce of acute rejection, reversibility of acute rejection, development of a subsequent acute rejection, and incidence of graft loss due to re jection in 154 children (<18 years of age) after primary renal transpl antation. Most patients (n = 139) were treated with quadruple immunosu ppression (antibody, azathioprine, prednisone, cyclosporine). Treatmen t of the first acute rejection episode (ARE) consisted of antibody and increased prednisone (68%) or increased prednisone alone (30%), and w as not significantly different between the age groups. Transplants wer e from living donors (LRD) in 80% of cases. Patients were followed for at least 1 year (mean 58+/-30 months); 68% (105/154) of recipients ex perienced 1 or more ARE. The incidence of ARE was significantly lower in patients <2 years of age (45%) compared with patients 2-5 (76%, P = 0.01), 6-12 (78%, P = 0.005), and 13-17 (76%, P = 0.009) years of age . There was no significant difference in the 1-, 2- and 5-year patient or graft survival rates, the development of a subsequent acute reject ion, or the incidence of graft loss due to acute rejection when analyz ed by age group. These data suggest that the impact of on ARE is simil ar for younger and older children in our population receiving predomin antly LRD transplants and quadruple immunosuppression.