A 100% 2-year graft survival can be attained in high-risk 15-kg or smallerinfant recipients of kidney allografts

Background: Infants make up the most high-risk, difficult to care for subgr oup undergoing kidney transplantation, with the lowest 1- and 2-year graft survival rates of any other age group. The principal causes of graft loss h ave been graft thrombosis, primary nonfunction, technical error, and irreve rsible acute rejection. Hypothesis: Infants undergoing kidney transplantation can achieve near 100% graft survival at 2 years following surgery, despite their very high-risk status. Design: Analysis of 45 consecutive kidney transplants performed in patients weighing less than or equal to 15 kg during an 8-year period beginning Aug ust 1991. Patients included complex referrals from throughout the United St ates and all received transplants and were cared for by the same pediatric kidney transplantation team. Results: Mean weight at transplantation was 11.2 kg. Renal failure was due to congenital or urologic causes in the majority (53%) of cases. Size-discr epant adult-sized kidney grafts were transplanted in 80% of patients; 64% r eceived live-donor grafts; 78% were receiving dialysis prior to transplanta tion; and 27% had extremely small bladders (<20 cm(3)) requiring modificati on of the ureteral implantation. Excluding 1 transplant-unrelated death, gr aft and patient survival at 2 years was 100%. Eight-year patient and graft survival rates (for our combined live and cadaver donor series) were 89.6% and 84.6%, respectively. This compares favorably with much lower graft surv ival in low-risk adult recipients. Delayed graft function occurred in only 1 patient (2%). Rate of incidence of rejection was 9.3% within 2 years of t ransplantation and the overall rejection rate was 15.5%. No graft was lost to vascular thrombosis, primary nonfunction,technical error, or acute rejec tion. The mean creatinine level was 53.04 mu mol/L (0.6 mg/dL) and 61.9 mu mol/L (0.7 mg/dL) at 1 and 2 years, respectively, and 88.4 mu mol/L (1.0 mg /dL) at 3, 4, and 5 years after transplantation. Conclusion: One hundred percent 2-year and excellent 8-year graft survival rates can be achieved in what has historically been the highest-risk and mo st difficult to care for patient subgroup undergoing kidney transplantation .