Kidney transplanted children come of age

Background. The aim of renal replacement therapy in children is to restore their potential for normal growth and development in order to reach mature adulthood. Because pediatric kidney transplantation started in the late 196 0s, it is now possible to document the progress and outcome of these patien ts from transplantation in childhood to survival into adulthood. Methods. In this single-center study, all 150 children born before December 1977 and having received a kidney transplant between 1970 and 1993 were se lected for long-term follow-up. The mean age at transplantation was 12.1 ye ars (range 3.2 to 16.7), and the mean follow-up was 13.1 years (range 2.0 t o 25.0). In December 1995, 124 grown-up patients with a mean age of 25.4 ye ars (range 18.4 to 40.3) were alive, 89 with a functioning graft. Fifty had the first graft functioning longer than 10 years. The fate of all patients was traced, and those living were analyzed in regard to their somatic and socioeconomic states. Results. The actuarial 25-year survival rate for the patients was 81%, and for the first graft it was 31%. The best graft survival rates were observed after living related donation, preemptive transplantation, and immunosuppr ession with cyclosporine. The latter benefit, however, vanished after eight years. The mean creatinine clearance declined over the years from 76 to 45 ml/min/1.73 m(2), and the incidence of hypertension increased to more than 80% of the patients. Malignancies occurred in 2.6%. Final height was stunt ed in 44% of noncystinotic patients, whereas all patients with cystinosis w ere extremely growth retarded. Twenty seven percent suffered from additiona l disabilities. A majority of adult patients were rehabilitated in regard t o education and socioeconomic status, and 14% were unemployed. Conclusions. The results indicate that renal transplantation in children le ads to a high degree of rehabilitation in adulthood. The life of a kidney t ransplant, however, is limited, which points out the need for more specific immunosuppression with fewer side-effects in order to reach the goal of li felong graft function.