Kidney transplantation in children: A single center experience

Purpose: We reviewed our most recent 10-year experience with kidney transpl antation in children to determine the morbidity and mortality of the proced ure, and to identify factors that affected outcome. Materials and Methods: A total of 107 renal transplants were done in 95 chi ldren 1 to 17 years old (mean age 10.9) during the 10-year period ending Ja nuary 1, 1997. The 4 most common causes of end stage renal disease were ren al dysplasia, reflux nephropathy, obstructive uropathy and systemic immunol ogical diseases. Cyclosporine based immunosuppression was used in all but 2 recipients, After April 1991 antilymphocyte antibody induction, coagulopat hy screening, systemic anticoagulation and cytomegalovirus prophylaxis were incorporated into the protocols. The effects of kidney source, recipient g ender, recipient age, preformed anti-HLA antibody level, preemptive renal t ransplantation, cytomegalovirus risk, antilymphocyte antibody induction the rapy and date of renal transplantation on kidney graft survival were examin ed with the log rank test. Results: The 1-year graft and patient survival rates were 91 and 99%, respe ctively. The most common causes of graft failure were rejection and recurre nce of primary renal disease. The only factors that significantly (p <0.05) influenced graft survival were antilymphocyte antibody induction immunosup pression and kidney transplantation after April 1991. Three urological comp lications required surgical correction. Medical morbidity included hyperten sion in 48.6% of the cases, short; stature in 46.6% and obesity in 58.9%. Conclusions: Pediatric renal transplantation can be done with acceptable mo rbidity, a low rate of technical complications and low mortality. Hypertens ion, chronic rejection and abnormal body habitus continue to be problematic .