title: The 1989 report of the North American Pediatric Renal Transplant Cooperative Study.
abstract: This report of the North American Pediatric Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 children with 761 transplants from 1 January 1989 to 16 February 1989. Data collection was initiated in October 1987 and follow-up of all patients is ongoing. Transplant frequency increased with age; 24% of the patients were less than 5 years, with 7% being under 2 years. Common frequent diagnoses were: aplastic/dysplastic kidneys (18%), obstructive uropathy (16%), and focal segmental glomerulosclerosis (12%). Preemptive transplant, i.e., transplantation without prior maintenance dialysis, was performed in 21% of the patients. Dialytic modalities pretransplant were peritoneal dialysis in 42% and hemodialysis in 25%. Bilateral nephrectomy was reported in 29%. Live-donor sources accounted for 42% of the transplants. Among cadaveric donors, 41% of the donors were under 11 years old. During the first post-transplant month, maintenance therapy was used similarly for live-donor and cadaver source transplants, with prednisone, cyclosporine, and azathioprine used in 93%, 83%, and 81%, respectively. Triple therapy with prednisone, cyclosporine, and azathioprine was used in 78%, 75%, and 75% of functioning cadaver source transplants at 6 months, 12 months, and 18 months as opposed to 60%, 63%, and 54% for live-donor procedures, with single-drug therapy being uncommon. Rehospitalization during months 1-5 occurred in 62% of the patients, with treatment of rejection and infection being the main causes. Additionally, 9% were hospitalized for hypertension. During months 6-12 and 12-17, 30% and 28% of the patients with functioning grafts were rehospitalized. Times to first rejection differed significantly for cadaver and live-donor transplants. The median time to the first rejection was 36 days for cadaver transplants and 156 days for live-donor transplants. Overall, 57% of treated rejections were completely reversible although the complete reversal rate decreased to 37% for four or more rejections. One hundred and fifty-two graft failures had occurred at the time of writing, with a 1-year graft survival estimate of 0.88 for live-donor and 0.71 for cadaver source transplants. In addition to donor source, recipient age is a significant prognostic factor for graft survival. Among cadaver donors, decreasing donor age is associated with a decreasing probability of graft survival. Thirty-five deaths have occurred; 16 attributed to infection and 19 to other causes. The current 1-year survival estimate is 0.94. There have been 9 malignancies.
authors.affiliation: Clinical Coordinating Center, Brooklyn, NY 11203.
authors.forename: S R
authors.initials: SR
authors.lastname: Alexander
authors.forename: G S
authors.initials: GS
authors.lastname: Arbus
authors.forename: K M
authors.initials: KM
authors.lastname: Butt
authors.forename: S
authors.initials: S
authors.lastname: Conley
authors.forename: R N
authors.initials: RN
authors.lastname: Fine
authors.forename: I
authors.initials: I
authors.lastname: Greifer
authors.forename: A B
authors.initials: AB
authors.lastname: Gruskin
authors.forename: W E
authors.initials: WE
authors.lastname: Harmon
authors.forename: P T
authors.initials: PT
authors.lastname: McEnery
authors.forename: T E
authors.initials: TE
authors.lastname: Nevins
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D009656:North America; D010530:Peritoneal Dialysis; D011379:Prognosis; D006435:Renal Dialysis; D013997:Time Factors; D014019:Tissue Donors