END-STAGE RENAL-FAILURE IN CHILDREN YOUNGER THAN 6 YEARS - RENAL-TRANSPLANTATION IS THE THERAPY OF CHOICE

Between 1975 and 1994, 46 children under 6 years of age received a tot al of 52 renal transplants. Obstructive uropathy and dysplasia account ed for most causes of terminal renal failure (17 and 12 cases respecti vely). Four patients required a second, 1 patient a third transplantat ion. Cadaveric organs were used on 33 occasions; 19 patients received a living-related donor kidney. Immunosuppression was performed with az athioprine in 5, with cyclosporine A in 21 and combined azathioprine/c yclosporine therapy in 20 cases. After 1 year, graft survival was 81%, and after 5 years 78%. Creatinine clearance declined slightly between 1 and 5 years from 69 to 56 ml/min per 1.73 m(2). Main causes of graf t failure were thrombotic complications in 6 cases and death with func tioning graft in 5 cases. Graft thrombosis occurred only in grafts fro m young donors under the age of 7 years and after vascular anastomosis to the iliac vessels. Only two transplants were lost in rejection epi sodes. Patient survival was 94% after 1 and 90% after 5 years. Two pat ients died due to septiacemia, 1 died of a ruptured aortic aneurysm, 1 of cerebral ischaemia and 1 suddenly of unknown cause. Patient and gr aft survival was not different compared with 204 patients aged 6-16 ye ars who received a renal transplantation during the same time period a t our institution. After transplantation the patients receiving cyclos porine A showed a marked catch-up growth in the 1st year. The median s tandard deviation score (SDS) of body length improved from -2.63 to -1 .39 standard deviations. Conclusion Renal transplantation is the treat ment of choice in end-stage renal failure in children under 6 years.