Long-term outcome of paediatric renal transplantation: follow-up of 300 children from 1973 to 2000.
OBJECTIVE
To report our experience of paediatric renal transplantation at Great Ormond Street and Royal Free Hospitals since the inception of the programme.


METHODS
Retrospective review of the patient and transplant survival and influencing factors in the 300 children transplanted between 1973 and 2000.


RESULTS
300 children had received a total of 354 transplants; 56 were living-related donations. The median age at transplantation was 10.3 (range 1.4-17.9) years. Forty-four percent had congenital structural abnormalities of the urinary tract. Forty-six children required a second and 8 a third transplant before transfer to an adult unit. The overall patient survival at 5, 10, and 20 years was 97, 94, and 72%, respectively. In the overall cohort, the donor type (deceased donor or living-related donor) did not affect mortality, nor did age at transplantation, but those transplanted before 5 years of age had a significantly shorter post-transplant survival time (p < 0.0001). Transplant survival (first transplant) for deceased and living-related donors was 66 and 87% at 5 years (p < 0.01), 51 and 54% at 10 years, and 36% at 20 years (deceased-donor transplants only). Although the overall transplant survival was inferior in children transplanted before 2 years of age (p < 0.03), in the most recent cohort (1990-2000), age did not affect the outcome. On multiple regression analysis, the only predictor of transplant survival was the era of transplantation (p < 0.001). The median final height was within the normal range for males and females; 7 patients received growth hormone after transplantation.


CONCLUSIONS
The outlook for successful transplantation is improving, and in the last decade was unaffected by age at transplantation. The survival of living-related donor transplants is superior to deceased-donor transplants for the first 5 years. From the above data, we can predict that a 10-year-old child receiving a renal transplant in 2000 and on ciclosporin-based immunosuppression can expect a transplant half-life of 13.1 years from a living-related donor and one of 10.8 years from a deceased-donor transplant.
Rees
Lesley
L
Department of Nephro-Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK. ReesL@gosh.nhs.uk
Shroff
Rukshana
R
Hutchinson
Carol
C
Fernando
Oswald N
ON
Trompeter
Richard S
RS
D000293:Adolescent; D000367:Age Factors; D001827:Body Height; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D004651:Employment; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine