Pre-emptive renal transplantation in children

Background: Renal transplantation is a definitive therapeutic modality in e nd-stage renal disease (ESRD). Most ESRD patients in Japan experience dialy sis prior to renal transplantation. The present study was undertaken to exa mine the usefulness of pre-emptive renal transplantation (PET). Methods: Between 1987 and 1998, 255 renal transplantations were carried out by the authors. Among those consecutive cases, 10 were cases of PET. In ni ne pediatric cases, demographics, graft and patient survival, height growth and benefits from successful transplantation were studied and compared wit h age-matched dialyzed transplantation controls. Results: All transplantation was living-related. There was a disparity of c auses of ESRD between the two groups. In PET, acquired renal deterioration due to a congenital lower urinary tract disorder was the major cause. Graft and patient prognosis was favorable in both groups. Growth retardation in PET patients under 15 years of age was significantly less apparent at the t ime of transplantation and after 3 years compared to the control. The benef its from transplantation were different in the two groups. Most PET patient s felt an improvement of their physical condition; however, all of the cont rol patients felt that the major boon was the freedom from the restriction of the daily diet and time for dialysis. Conclusion: In pediatric renal transplantation, short-term preceding dialys is does not have a detrimental effect, but PET could benefit ESRD patients by maintaining their quality of life. Moreover, PET minimizes the productio n of renal dwarfism in prepubertal children. Thus, PET should be taken into consideration in the choice of renal replacement therapy.