Successful long-term outcomes using pediatric en bloc kidneys for transplantation.
OBJECTIVE
The objective of our study was to determine whether acceptable long-term graft survival and function can be achieved using pediatric en bloc renal transplants by employing specific immunologic and selection strategies.


METHODS
A retrospective analysis of pediatric en bloc kidney transplants at a single institution was performed. A Kaplan-Meier analysis was used to evaluate graft survival.


RESULTS
Fifty-seven adult recipients with at least a 1-year follow-up period were successfully transplanted using pediatric en bloc kidneys between 1993 and 1998. Complete data regarding immunosuppression were available for 53 patients. All patients had a cyclosporine (CsA)- or tacrolimus (TAC)-based regimen with either azathioprine (Aza) or mycophenolate mofetil (MMF) and corticosteroids. All but two received induction with OKT3. One-, 3-, 4-, 5- and 7-year graft survival was calculated to be 88%, 86%, 83%, 68% and 68%, respectively. The mean serum creatinine value at 3 years was 1.0+/-0.4 mg/dL. Thirteen patients (23%) had biopsy-proven rejection. Ten of 19 (53%) patients treated with CsA/Aza had rejection, whereas 2/15 (13%) on CsA/MMF and 1/19 (5%) of patients on TAC/MMF had rejection. Nine patients (16%) had surgical complications.


CONCLUSIONS
Excellent long-term results can be achieved in pediatric en bloc kidney transplantation using OKT3, TAC and MMF in carefully selected adult recipients.
Hiramoto
Jade S
JS
Department of Surgery, University of California San Francisco, USA.
Freise
Chris E
CE
Randall
Henry R
HR
Bretan
Peter N
PN
Tomlanovich
Stephen
S
Stock
Peter G
PG
Hirose
Ryutaro
R
D000367:Age Factors; D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D009929:Organ Size; D044469:Racial Groups; D012727:Sex Characteristics; D013997:Time Factors; D023001:Transplantation Tolerance / Q000276:immunology*