EARLY RISK-FACTORS IN PEDIATRIC RENAL-TRANSPLANTATION AT A SINGLE-CENTER

Background/Purpose: Renal transplantation is the preferred treatment f or renal failure in childhood, but the incidence of graft failure is g enerally higher than that in adult recipients. A single center was stu died to determine if there were any correctable factors that could con tribute to graft failure. Methods: Recipient, donor, and perioperative factors were analyzed using standard statistical tests in 59 pediatri c renal transplants performed between 1992 and 1995 using standard cyc losporin-based immunosuppression. Results: Three factors were found to be significantly different between those recipients with good graft f unction and those who either died or were returned to dialysis. Any hi story of donor hypotension was a detrimental factor (P < .05, chi(2) t est). In addition, those with failed grafts were more likely to have r eceived their grafts from younger donors (P = .025, Mann Whitney U tes t). A third risk factor was a low postoperative central venous pressur e in those whose graft ultimately failed (P = .0012, Mann Whitney U te st). Conclusions: With a pediatric recipient who is stable and has a l ow priority for a renal graft, small donors, particularly those who ha ve experienced hypotension, should be considered not suitable for tran splantation. The chances of a successful graft can be improved by good communication between surgeon, pediatrician, and anesthetist. The imp ortance of maintaining a positive central venous pressure is emphasise d. Copyright (C) 1998 by W.B. Saunders Company.