Long-term follow-up of renal transplantation in children: a Dutch cohort study.
BACKGROUND
Few data exist on long-term morbidity, overall survival, and graft survival of pediatric renal transplantation.


METHODS
The authors performed a long-term cohort study in all Dutch patients, born before 1979, with onset of end-stage renal disease (ESRD) between 1972 and 1992 at age 0 to 15 years. Data on graft survival and determinants of outcome were obtained by reviewing all medical charts. The health status was assessed by cross-sectional examination of surviving patients.


RESULTS
Three hundred ninety-seven transplantations were performed in 231 of all 249 patients, of whom 25 died with a functioning graft. Cardiovascular disease was the most prominent cause of death. Graft survival estimates for all transplantations were 59.2%, 45.3%, 35.4%, and 30.3% at 5, 10, 15, and 20 years, respectively. In comparison with azathioprine, cyclosporine as the immunosuppressant was associated with increased graft survival in retransplantations but not in first transplantations. Cross-sectional examination was performed on 110 patients. In 44 patients, the most recent graft survival exceeded 15 years. Co-morbidity was found in 40% of all patients; motor, hearing, or visual disabilities were found in 19%. Bone disease, headaches, itching, and tremors were the most reported disabling problems. Cyclosporine use was associated with hypertension and a history of epilepsy. Compared with all age-matched Dutch inhabitants, the educational attainment was low, and unemployment and parental dependency were high.


CONCLUSIONS
The authors' results emphasize the need for reducing cardiovascular disease and metabolic bone disease in pediatric ESRD, a policy toward less toxic antirejection therapy, a more strict treatment of hypertension, and more attention for schooling and social development toward independence.
Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, The Netherlands. j.w.groothoff@amc.uva.nl
Jaap W
JW
Groothoff
Karlien
K
Cransberg
Martin
M
Offringa
Nicole J
NJ
van de Kar
Marc R
MR
Lilien
Jean Claude
JC
Davin
Hugo S A
HS
Heymans
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data; D009426:Netherlands; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors