RENAL-TRANSPLANTATION IN YOUNG-CHILDREN

Aims: To review the outcome of renal transplantation in small children treated with triple immunosuppression at a single Australian centre. Methods: The medical records of all children under the age of five yea rs undergoing renal transplantation from 1988 were reviewed. The durat ion of follow-up was 30 months (range 18-36). Results: Six children re ceived seven renal allografts (five living-related [LR] and two cadave ric [CD]). They had a median age of 3.75 years (range 1.5-4.9) and wei ght of 11.6 kg (9.1-14.5) at the time of transplantation. All patients received an immunosuppressive regime involving cyclosporin A, azathio prine and prednisolone. There were no deaths. The only graft lost was a CD graft (severe acute rejection within one week of transplantation) . Hypertension occurred in all recipients and usually required more th an one antihypertensive drug for treatment. Renal function measured by serum median creatinine concentration (range) was 0.05 mmol/L (0.03-0 .11) at three months (n = 6) and 0.10 mmol/L (0.07-0.22) at 30 months (n = 4). Growth estimated from median (range) height standard deviatio n scores was -1.97 (-1.36--4.04) at three months (n = 6) and -1.90 (-1 .74-2.50) at 30 months (n = 4). No patient was entirely weaned from pr ednisolone. Cyclosporin A side effects included hirsutism (five patien ts), gingival hyperplasia (six patients) and nephrotoxicity (three pat ients). Conclusions: Satisfactory patient and graft survival can be ac complished in this recipient age group. The results compare with other international experience and accumulating Australian experience. Hype rtension and poor skeletal growth were consistent observations. The lo ng-term outcome of renal function using triple immunosuppression remai ns to be determined.