A longitudinal study of children who received renal transplants 10-20 years ago.
BACKGROUND
We have previously reported on our 10-year experience of renal transplantation in children in the cyclosporine era, that is, from December 1981 until December 1991. In this paper, we report on the same children observed for another 10 years.


METHODS
Of 53 children who received a renal transplant between 1981 and 1991, 47 survived and were observed for 10 to 20 years. Immunosuppression consisted of cyclosporine, prednisolone, and azathioprine. Yearly clinical examinations were performed.


RESULTS
Overall, actual patient survival is 91%, 89%, and 89%, and actual graft survival 85%, 77%, and 66% at 1, 5, and 10 years, respectively. No patients have died during the last 10 years. Twenty-six grafts were lost over 20 years. Thirteen of those were lost during the present follow-up (10-20 years): 11 in chronic rejection and 2 because of development of renal cell carcinoma. No other malignancies were noted. Mean glomerular filtration rate decreased from 58+/-19 at 1 year (n=42) to 44+/-16 mL/min/1.73 m2 body surface area at 10 (n=33) years. Hypertension was treated in 46%, 40%, and 66% of the children at 1, 5, and 10 years, respectively; two of them showed left ventricular hypertrophy 10 years after transplant. Minor cataracts without visual disturbance were found in 45% of patients. All children except three with mental retardation are, or have been, attending normal day care or normal school.


CONCLUSIONS
Social integration is good, and severe complications are scarce, even when renal transplantation occurred at a very young age.
Englund
Märta
M
Department of Paediatrics, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden. marta.englund@klinvet.ki.se.
Berg
Ulla
U
Tydén
Gunnar
G
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000401:mortality; D002648:Child; D002657:Child Development; D016572:Cyclosporine / Q000008:administration & dosage; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D006509:Hepatitis B / Q000401:mortality; D006526:Hepatitis C / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000502:physiology; D007680:Kidney Neoplasms / Q000401:mortality; D016030:Kidney Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D016572:Cyclosporine