SUPERIOR OUTCOMES IN PEDIATRIC RENAL-TRANSPLANTATION

Background: Nationally, results of renal transplantation in children, particularly in small children, are inferior to those obtained in adul ts. Objective: To determine factors important for success in renal tra nsplantation in children. Design: Results of 108 consecutive renal tra nsplantations performed in patients aged 7 months to 18 years were rev iewed and compared with those reported by the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), the national registry. Results: One-, 2-, and 3-year graft survival rates (+/-SE) were 99%+/- 1%, 95%+/-3%, and 93%+/-4%, respectively, for living donor grafts and 97%+/-3%, 92%+/-6%, and 92%+/-6%, respectively, for cadaver grafts. In cidence of acute rejection was half that reported by NAPRTCS. There we re no graft tosses for technical reasons (19% in NAPRTCS). Twelve perc ent of patients were younger than 2 years (6% in NAPRTCS); 17% were 2 to 5 years old (16% in NAPRTCS). Most small children received an adult -sized kidney. Ninety-three percent of recipients weighing 15 kg or le ss received postoperative mechanical ventilation assistance to optimiz e fluid resuscitation and perfusion of adult-sized kidneys. Structural abnormalities of the urinary tract were present in 53.7% of the patie nts (48.5% in NAPRTCS; adults, 5.3%). Nephroureterectomy was required in 38 children; in 27 (71%) of them, it was performed at the time of t ransplant surgery. Conclusions: Excellent results can be obtained in p ediatric renal transplantation by strict adherence to surgical detail, tight immunosuppressive management, aggressive fluid management in th e small child, and careful integration of urologic and transplant surg ery.