Paediatric renal transplantation: experience in Lausanne 1971-1998

Aims of the study: Analysis of indications and results of paediatric renal transplantation in a single centre, before and after the introduction of cy closporine A (CSA). Methods: Historical retrospective study. Results: 19 transplantations were performed in 14 patients (5 second grafts ) between 1971 and 1987 (group I). 13 patients were transplanted between 19 88 and 1998 (no second transplant) (group II). In group II, all the patient s had immunosuppression with CSA, but none in group I. Group II, with CSA, showed better renal survival than patients without CSA. In group I, obstruc tive uropathies (posterior urethral valves, pyelo-ureteral junction stenosi s, vesicoureteral reflux) represent a common cause (35%) of terminal chroni c renal failure (TCRF), whereas in group II they represent only 15% of the causes and chronic glomerulonephritis is the most common cause(69%) of TCRF . Acute and chronic graft rejections were the cause of 9 and 1 graft losses in group I and II respectively. Living related donors account for 14% of a ll renal transplantations in group I and 46% in group II. Conclusions: The incidence of paediatric patients referred to Lausanne for TCRF is stable. We have observed a constant and steady decrease in obstruct ive uropathies leading to TCRF and renal transplantations, whereas glomerul onephritis are increasingly frequents Graft survival has much improved sinc e the introduction of cyclosporine A, without an increase in morbidity. In carefully selected cases, intrafamilial renal transplantation provides good results and helps to shorten the time spent on dialysis.