Renal transplantation in children. A report of the North American Pediatric Renal Transplant Cooperative Study.
BACKGROUND
Previous studies of renal transplantation in children have focused on the survival of grafts and patients. Little information is available about the cause of renal disease, the sources of donated organs, or children's growth after transplantation. The North American Pediatric Renal Transplant Cooperative Study was organized to identify the diseases that require transplantation and to analyze factors that affect the success of transplantation in children.


METHODS
We collected data from 73 pediatric transplantation centers from 1987 through 1990. These data included information about demographic characteristics of patients, graft function, and therapy one month after transplantation and every six months thereafter for each patient 17 years of age or younger.


RESULTS
Altogether, 1550 children received 1667 renal allografts during this period; 31 percent of the children were five years of age or younger. Forty-three percent of the transplanted kidneys came from a living related donor, and 57 percent from a cadaver. The two most common causes of renal disease leading to transplantation were congenital malformations of the kidneys and urinary tract (42 percent of the patients) and focal segmental glomerulosclerosis (12 percent). One year after transplantation, the rate of graft survival in recipients of a kidney from a living related donor was 89 percent; it was 80 percent after three years. For recipients of cadaver kidneys, the comparable rates were 74 percent and 62 percent, respectively (P less than 0.001). The best growth was observed in patients who were no more than five years old at the time of transplantation. During follow-up, 79 patients died, and cancer developed in 12 patients.


CONCLUSIONS
The most common causes of end-stage renal disease in children and adolescents are congenital malformations of the kidneys and urinary tract and focal segmental glomerulosclerosis. The rates of graft survival at one and three years are better in children and adolescents who receive a kidney from a living related donor than in those who receive a kidney from a cadaver.
McEnery
P T
PT
Children's Hospital Medical Center, Cincinnati.
Stablein
D M
DM
Arbus
G
G
Tejani
A
A
D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006128:Growth; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007668:Kidney / Q000002:abnormalities; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D014019:Tissue Donors; D014551:Urinary Tract / Q000002:abnormalities
D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents