Graft function 5-7 years after renal transplantation in early childhood

Background. Low recipient age is still a risk factor for graft failure afte r kidney transplantation (Tx), Detailed prospective reports on long-term gr aft function in small children after renal Tx are still lacking, Methods. Forty-nine kidney allograft recipients who received transplants be fore the age of 5 years were followed prospectively. The most common diseas e was congenital nephrotic syndrome of the Finnish type. Twenty patients we re recipients of living related donors (LRD), and 29 were cadaveric kidney (CAD) recipients. All patients received triple immunosuppression. Glomerula r filtration rate (GFR), effective renal plasma now (ERPF), sodium, urate, and potassium handling, and concentrating capacity were studied for up to 7 years after Tx. Results. Patient survival 7 years after Tx was 100% for LRD and 96% for CAD recipients. Graft survival was 94% for LRD and 79% for CAD recipients (P=N S) and 89% and 83% for children >2 years and <2 years of age at Tx, respect ively (P=NS). Five years after Tx, GFR was 70 vs. 64 and ERPF was 380 vs. 3 10 ml/min/1.73 m(2) for LRD and CAD recipients, respectively (P=NS). Mean a bsolute GFR remained stable. GFR was lower in children who received transpl ants at <2 years than in children who received transplants at >2 years of a ge, 54 vs. 75 ml/min/1.73 m(2) (P=0.02), Sodium handling remained intact, b ut hyperuricemia was seen in 43-67%; 17-33% showed abnormal handling of pot assium; and most patients had a subnormal concentrating capacity. Conclusions. Excellent long-term graft survival and good graft function can be achieved with triple immunosuppression, even in young CAD kidney recipi ents.