RECURRENCE OF RENAL-DISEASE AFTER KIDNEY-TRANSPLANTATION IN CHILDREN - 24 YEARS OF EXPERIENCE IN A SINGLE-CENTER

The aim of this study was to assess the frequency and clinical implica tions of a recurrence of the original renal disease in children after kidney transplantation, Thus, the records of patients with immunologic al and metabolic diseases transplanted between 1970 and 1994 were retr ospectively analyzed. There were 113 renal transplantations in 99 pati ents, who had the following original diseases: focal segmental glomeru losclerosis (FSGS), membrano-proliferative glomerulonephritis type I a nd type II (MPGN I, II), Henoch-Schoenlein nephritis, IgA-nephropathy, hemolytic uremic syndrome (HUS) and hyperoxaluria type I (PH I) and o ther rare diseases. Recurrences were observed in FSGS, MPGN II, HUS an d PH I but not in the other diseases. In FSGS, the recurrence rate was 20% with graft failure in 5 of 6 grafts. No specific risk factors for recurrent FSGS could be determined. In MPGN II, the recurrence was 60 % but the loss of grafts occurred at the same rate as in the non-recur rence group. In HUS, recurrence was seen in 4 out of 24 renal grafts ( 16.6%) with subsequent graft loss in all cases. All cases had suffered from an atypical HUS. PH I recurred in 4 of 5 allografts with graft l oss in all patients. The remaining graft was transplanted after a live r transplantation and graft function was well preserved for 4 years. W e confirm that the risk of recurrence with loss of the graft is high i n a certain group of renal diseases. In these the indication for trans plantation, particularly with living related donor kidneys, needs spec ial evaluation. A better understanding of the pathomechanism of the di seases should lead to prevention of recurrence, as in PH I in which a liver transplant is now the primary option.