title: First living related kidney transplantation results in excellent outcomes for small children.
abstract: OBJECTIVE
  The aim of this study was to evaluated the outcomes of living related kidney transplantation in small children.
  
  
  METHODS
  Ten pediatric patients with body weights less than 10 kg received parental kidney transplants (five mothers and five fathers). An intra-abdominal approach was used in nine children and a retroperitoneal approach in one child. Bilateral, left, or right nephrectomy was performed in seven, two, and one child, respectively. Immunosuppression consisted of either cyclosporine (n = 7) or tacrolimus (n = 3) with either mizoribine (n = 4) or mycophenolate mofetil (MMF) (n = 5) or azathioprine (n = 1), and methylprednisolone (n = 10). Antilymphocyte globulin was used in the first series of four children; basiliximab in the most recent five children.
  
  
  RESULTS
  All renal allografts functioned immediately after transplantation despite the mismatched size of the large renal allografts. Nine of 10 children were alive with a functional allograft at 6 to 196 months posttransplantation. One child died of intra-abdominal bleeding 5 days posttransplantation. One child has suffered chronic allograft nephropathy 11 years posttransplantation (serum creatinine 3.3 mg/dL). The remaining eight children display good renal function (serum creatinine = 0.2 to 1.43 mg/dL). Steroids were withdrawn in eight of nine children; one child continues on alternative-day therapy. One child (LD55) exceeded the mean standard height. The most recent height standard deviation (SD) scores were superior (-1.75 +/- 1.39 [-3.83 to 0.54]; P < .0082) to those at transplantation (-2.91 +/- 0.79 [-2.00 to -4.14]).
  
  
  CONCLUSIONS
  The outcomes of living related kidney transplantation in small children were excellent despite the operative risks and the difficulty of cardiovascular and fluid management. Transplantation for small children appears to result in much better quality of life and growth than dialysis.
authors.affiliation: Department of Nephrology, Toho University, School of Medicine, Tokyo, Japan. aaikawa@med.toho-u.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Aikawa
authors.forename: K
authors.initials: K
authors.lastname: Arai
authors.forename: T
authors.initials: T
authors.lastname: Kawamura
authors.forename: K
authors.initials: K
authors.lastname: Sugiyama
authors.forename: M
authors.initials: M
authors.lastname: Muramatsu
authors.forename: Y
authors.initials: Y
authors.lastname: Itabashi
authors.forename: T
authors.initials: T
authors.lastname: Ohara
authors.forename: O
authors.initials: O
authors.lastname: Motoyama
authors.forename: A
authors.initials: A
authors.lastname: Hasegawa
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000077552:Basiliximab; D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007668:Kidney / Q000033:anatomy & histology*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008297:Male; D009929:Organ Size; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab