[Mortality in pediatric renal transplants: 15 years' experience].
The aim of the study was to analyse retrospectively the patient survival and mortality risk factors in renal transplant children at Edouard-Herriot hospital, Lyon.


METHODS
One hundred and ninety four patients 0 to less than 18 years of age received a renal transplant between April 1987 and January 2002. We collected data concerning the age at transplantation, the mean duration of dialysis prior to transplantation, the type of donor (living related: LRD, or cadaver: CAD) as well as long term follow-up of all the patients. Eleven patients died during the study period and we collected mortality and morbidity factors.


RESULTS
Mean age at transplantation was 9.5 years (range: 0.6-17.9 years); 16 children were transplanted before 2 years of age. Eighty six percent received a first graft, 10% a second graft, and 3% a third graft. One third of the patients had preemptive transplantation. The graft was carried out respectively from a LRD in 18% and from CAD in 82% of the cases. Eleven patients (5.7%) died during this period; four of them were transplanted twice. Death occurred within 2.4 years after transplantation (range: 2 days-6.3 years). Five of these deceased children developed an acute rejection episode treated with methylprednisolone pulses and OKT3 monoclonal antibodies. Four had a cytomegalovirus (CMV) infection and three required repeated surgery. The causes of death were bacterial infections (4/11), CMV infection (2/11), neurological involvement (2/11), Burkitt lymphoma (1/11) and unexplained sudden death (2/11).


CONCLUSIONS
The main causes of deaths in renal transplant children are bacterial infections. The improvement in patient survival probably will come from both better preventive approach to nosocomial infections and a less aggressive immunosuppression.
Service de transplantation rénale (Ugo), hôpital militaire de Tunis, 1008 Tunisie. harzallakais@yahoo.fr
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K
Harzallah
D
D
Floret
X
X
Martin
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P
Cochat
D000206:Actuarial Analysis; D000293:Adolescent; D017677:Age Distribution; D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality; D002051:Burkitt Lymphoma / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology / Q000401:mortality; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality; D003645:Death, Sudden / Q000453:epidemiology / Q000209:etiology; D005602:France / Q000453:epidemiology; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007223:Infant; D017053:Infection Control; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D009017:Morbidity; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data