IMPROVED SURVIVAL OF EN-BLOC RENAL-ALLOGRAFTS FROM PEDIATRIC DONORS

Purpose: We developed a technical and immunological protocol to increa se survival of renal transplants from pediatric donors. Materials and Methods: En bloc kidneys (22) were procured from donors weighing 2 to 14 kg. (1 to 60 months old) and transplanted into adult recipients. In group 1 (12 patients) sequential therapy was used for kidneys with mo re than 35 hours of cold storage and immediate triple therapy (cyclosp orine, azathioprine and prednisone) was used for those with less than 35 hours of cold storage. In group 2 (10 patients) OKT3 induction ther apy was used. Mean followup was 4.7 years. Results: Mean blood pressur e at 1 and 4 years was not significantly different between the groups. Mean serum creatinine was not significantly different between the gro ups at 1 year but it was significantly less in group 2 at 4 years (1.9 +/- 1.0 versus 1.2 +/- 0.24 mg./dl., p <0.05). At 1 year of followup the complication rate was 75% in 9 of 12 patients in group 1, includin g 4 infections or leaks (2 lost), 6 rejections (3 lost) and 3 cases of thrombosis or hemorrhage, and 20% (p <0.01) in group 2 (1 patient had the hemolytic uremic syndrome leading to graft loss). Graft survival was significantly greater in group 2 at all 4 years of followup (p = 0 .05). Conclusions: The success of pediatric en bloc renal transplantat ion can be enhanced by induction therapy in healthy recipients.