Renal transplantation in the first year of life: the treatment of choice for infants with end-stage renal disease.
The treatment of choice for end-stage renal failure within the first year of life is controversial. Between September 1970 and February 1991, we performed 28 kidney transplants (27 primary, 1 retransplant, 23 living donor, 5 cadaver) in infants less than 1 yr of age (mean, 7 +/- 2 months; range, 6 wk to 12 months). The 1-yr patient survival rate for living donor recipients was 100% versus 20% for cadaver recipients (P = 0.0001). The 1-yr graft survival rate for living donor recipients was 96% versus 20% for cadaver recipients (P = 0.001). The 1-yr patient survival rate for cyclosporin A (CSA) recipients (N = 12) was 100% versus 75% for non-CSA recipients (P = 0.03). The 1-yr graft survival rate for CSA recipients was 92% versus 75% for non-CSA recipients (P = 0.08). There was no difference in the number of rejection episodes or serum creatinine levels in CSA versus non-CSA recipients. Compared with pretransplant values, the mean posttransplant standard deviation scores (SDS) for height (N = 18), weight (N = 22), and head circumference (N = 8) improved: height SDS from -1.9 to -1.5 (not significant); weight SDS from -2.5 to 0.6 (P less than 0.0005); head circumference SDS from -2.0 to -0.7 (P = 0.01). Because no other renal replacement therapy can match these results, we conclude that renal transplantation is the treatment of choice for infants with end-stage renal failure.
Najarian
J S
JS
Department of Surgery, University of Minnesota, Minneapolis 55455.
Almond
P S
PS
Mauer
M
M
Chavers
B
B
Nevins
T
T
Kashtan
C
C
Matas
A J
AJ
D005069:Evaluation Studies as Topic; D005260:Female; D006085:Graft Survival; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods; D015993:Life Tables; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015996:Survival Rate