STEADY IMPROVEMENT IN RENAL-ALLOGRAFT SURVIVAL AMONG NORTH-AMERICAN CHILDREN - A 5-YEAR APPRAISAL BY THE NORTH-AMERICAN PEDIATRIC RENAL-TRANSPLANT COOPERATIVE STUDY

From 1987 through 1994, the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) has enrolled 1641 cadaver donor transplant s. For this study, we have analyzed one and two year graft survival by annual cohorts for the years 1987 through 1991. For the 1987 cohort o ne and two year graft survival was 72% and 65%, respectively, and for the 1991 cohort it was 83% and 78%, respectively. Using a proportional hazards model, and comparing the 1987 cohort to the 1991 cohort, the relative risk for graft failure was 1.40 (P = 0.02). Analysis of pract ice patterns revealed the following changes which may have been associ ated with this improved graft survival: (1) use of T cell induction an tibody, 38% in 1987 and 67% in 1991 (P less than or equal to 0.001); ( 2) the increased use of cyclosporine (CsA) post-transplant: in 1987, 8 7% were maintained on CsA at day 30 compared to 97% in 1991 (P < 0.001 ); (3) the mean higher daily maintenance CsA dose at 12 months post-tr ansplant which in 1987 was 6.5 mg/kg compared to 7.5 mg/kg in 1991 (P = 0.03); (4) the decreased use of random transfusions, 54% receiving > 5 transfusions in 1987 compared to 37% in 1991 (P < 0.001); and (5) de creased use of younger cadaver donors between 1987 and 1991 (P < 0.001 ).