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.
Department of Surgery, University of California San Francisco, USA.
Jade S
JS
Hiramoto
Chris E
CE
Freise
Henry R
HR
Randall
Peter N
PN
Bretan
Stephen
S
Tomlanovich
Peter G
PG
Stock
Ryutaro
R
Hirose
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*