Successful renal transplantation in children under 6 years of age.
To evaluate the efficacy of renal transplantation in small pediatric patients, we have reviewed 41 allografts performed in 39 children (28 M/11 F) less than 6 years of age between 1987 and 1998 in the North Italy Transplant Program. Of these patients, 39 had a cadaver donor and 2 a living-related donor, with ages ranging from 20 days to 35 years. The mean follow-up was 56 months. Graft survival was 74.5% and 70.5% at 1 and 5 years, respectively. The causes of graft lost were acute rejection (4), graft vascular thrombosis (4), and hemolytic uremic syndrome recurrence (1). Only 1 patient has died due to chickenpox. Double and triple immunosuppressive therapies were used in 63% and 37% of patients, respectively, on the basis of different center protocols, without differences in graft survival. Steroids were successfully administered on alternate days in 37% of patients, 6-12 months after transplantation. Thrombosis was reported in 2 of 6 kidneys from donors less than 1 year of age and in 2 of 35 donors older than 1 year (P < 0.05). Thirty rejections occurred in 23 patients: 7 episodes were steroid resistant and were treated with ATG/OKT3. Thirty-four infections were reported in 16 of 41 patients; of these 17 were viral, 14 bacterial, and 3 due to Mycoplasma. Four surgical complications were reported: 1 graft artery stenosis, 1 ureteral stenosis, 1 urinary leak, and 1 lymphocele. Mean height standard deviation score improved from -2.0 +/- 1.3 pre transplantation to -1.8 +/- 1.4, -1.5 +/- 1.3, and -1.5 +/- 1.5 at 1, 2, and 5 years post transplantation. Linear growth was significantly better in infants treated with alternate-day steroids. Hypertension was a frequent complication, since 19 of the 30 patients with a 5-year follow-up were still being treated with antihypertensive drugs. In conclusion, graft survival in patients less than 6 years old is satisfactory and similar to that obtained in children aged from 6 to 18 years (70.5% vs. 78.9% at 5 years, P = NS). Consequently, since there are many difficulties in managing infants on maintenance dialysis, an early transplant should be considered. Donors older than 24 months carry a low risk of vascular thrombosis and may be successfully grafted in infants.
Dall'Amico
R
R
Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy. roberto@child.pedi.unipd.it
Ginevri
F
F
Ghio
L
L
Murer
L
L
Perfumo
F
F
Zanon
G F
GF
Berardinelli
L
L
Basile
G
G
Edefonti
A
A
Garavaglia
R
R
Damiani
B
B
Valente
U
U
Fontana
I
I
Bertipaglia
M
M
Cardillo
M
M
Scalamogna
M
M
Zacchello
G
G
D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome