PREEMPTIVE RENAL-TRANSPLANTATION IN CHILDREN - REPORT OF THE NORTH-AMERICAN PEDIATRIC RENAL-TRANSPLANT COOPERATIVE STUDY (NAPRTCS)

Of 2213 primary transplants reported to NAPRTCS between 1/1/87 and 10/ 31/92, 581 (26.3%) were performed without prior dialysis. The rate of pre-emptive transplantation (PET) differed by donor source, 35.7% LD a nd 16.1% CD (p < 0.001); gender, 29.6% male and 21.1% female (p < 0.00 1); race, 30.1% white, 16.1% black, 19.5% hispanic, and 20.2% other (p < 0.001); recipient age, 0-1 yr 18.7%, 2-5 yr 27.9%, 6-12 yr 30.5%, a nd 13-17 yr 22.8% (p < 0.001). The graft survival rate was significant ly better for both the LD (p < 0.01) and CD (p = 0.01) grafts in the p re-emptive group; however, the differences were not significant after adjustment for other variables. The major reasons for pre-emptive tran splantation were the parents' desire to avoid dialysis and the recomme ndation of the nephrologist/surgeon. The data indicate that preemptive transplantation does not adversely impact on transplant outcome and t hat the desire to avoid dialysis is the primary motivating factor.