End-stage renal failure in children: 16 years' experience at one Australian centre.
Sixty-five children over one year and under 15 years of age began treatment for end-stage renal failure between 1973 and 1988. Sixty-one renal transplants were performed in 53 children, 39 of these were from living donors (38 were first-degree relatives and one was an emotionally related volunteer). Thirteen children, of whom seven had received transplants and six had not, died, including three children with functioning transplants; nine deaths occurred in the first eight years of the programme. Cumulative five-year and 10-year patient survival rates were 78% and 75%, respectively. Eighteen transplants failed, 12 as a result of rejection, five as a result of disease recurrence and one due to primary non-function. Cumulative five-year and 10-year transplant survival rates for first grafts were 66% and 53%, respectively. For living donor transplants these rates were 85% and 68%, respectively. Growth rates fell by 0.4 +/- 0.05 standard deviation score (SDS) per year in children undergoing dialysis, were normal in children with renal transplants receiving prednisone (change in SDS per year, -0.02 +/- 0.08) and increased by 0.36 +/- 0.07 SDS per year in children with transplants receiving cyclosporin A alone. Currently, 32 (82%) of 39 transplant recipients and 7 (58%) of 12 patients undergoing dialysis attend school or work full time. Although both dialysis and transplantation are acceptable therapies for children with end-stage renal failure, successful transplantation provides the best opportunity for satisfactory growth and development.
Hodson
E M
EM
Department of Nephrology, Royal Alexandra Hospital for Children, Camperdown, NSW.
Knight
J F
JF
Sheil
A G
AG
Roy
L P
LP
Harris
J P
JP
Rogers
J R
JR
Stephen
M S
MS
Boulas
J
J
Thompson
J F
JF
May
J
J
D000206:Actuarial Analysis; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006128:Growth; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution
D007166:Immunosuppressive Agents