Improved survival of en bloc renal allografts from pediatric donors.
OBJECTIVE
We developed a technical and immunological protocol to increase survival of renal transplants from pediatric donors.


METHODS
En bloc kidneys (22) were procured from donors weighing 2 to 14 kg. (1 to 60 months old) and transplanted into adult recipients. In group 1 (12 patients) sequential therapy was used for kidneys with more than 35 hours of cold storage and immediate triple therapy (cyclosporine, azathioprine and prednisone) was used for those with less than 35 hours of cold storage. In group 2 (10 patients) OKT3 induction therapy was used. Mean followup was 4.7 years.


RESULTS
Mean blood pressure at 1 and 4 years was not significantly different between the groups. Mean serum creatinine was not significantly different between the groups at 1 year but it was significantly less in group 2 at 4 years (1.9 +/- 1.0 versus 1.2 +/- 0.24 mg./dl., p <0.05). At 1 year of followup the complication rate was 75% in 9 of 12 patients in group 1, including 4 infections or leaks (2 lost), 6 rejections (3 lost) and 3 cases of thrombosis or hemorrhage, and 20% (p <0.01) in group 2 (1 patient had the hemolytic uremic syndrome leading to graft loss). Graft survival was significantly greater in group 2 at all 4 years of followup (p = 0.05).


CONCLUSIONS
The success of pediatric en bloc renal transplantation can be enhanced by induction therapy in healthy recipients.
Bretan
P N
PN
Department of Surgery, University of California School of Medicine, Renal Transplant Service of Harbor/UCLA, Torrance, USA.
Koyle
M
M
Singh
K
K
Barba
L
L
Ward
H
H
Sender
M
M
Avelino
L
L
Rajfer
J
J
D002675:Child, Preschool; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods*; D014019:Tissue Donors