title: Renal transplantation in children younger than 6 years old.
abstract: Herein we report our experience in renal transplantation in 38 children (40 transplants), ages 1 to 5 years, between 1989 and 2005. Demographics as well as patient and graft survivals are reported. Mean age at transplantation was 3.3 +/- 1.3 years, and mean weight was 14 kg (range, 5.7-25 kg); 92.5% were Caucasian, 7.5% African-Brazilian. The main etiology for end-stage renal disease (ESRD) was uropathic/vesicoureteral reflux (45%) followed by glomerulopathy (25%), congenital/hereditary diseases (10%), and hemolytic uremic syndrome (12.5%). Prior to transplantation, 5% were on hemodialysis, 85% on peritoneal dialysis, and 10% preemptive. All children were followed for at least 6 months posttransplantation, except 2 who died in the first month. In 75% of cases, kidneys were obtained from living-related donors, and in 25% from deceased donors. Thirty-nine kidneys were extraperitoneally placed. Primary immunosuppressant therapy consisted of cyclosporine (61%), tacrolimus (39%), mycophenolate (49%), and azathioprine (51%). A steroid-free protocol was used in 17% of patients. In the last 21 cases, basiliximab or daclizumab was added. There were 13 (32.5%) graft losses (4 artery/vein thromboses, 3 chronic rejections, 3 deaths, 3 other causes). The 5-year patient and graft survival rates were 89.6% and 72.2%. We have concluded that renal transplantation can be performed with good long-term results in children younger than 6 years old.
authors.affiliation: Complexo Hospitalar Santa Casa, FFFCMPA, Porto Alegre, RS, Brazil. cdgarcia1@uol.com.br
authors.forename: C D
authors.initials: CD
authors.lastname: Garcia
authors.forename: V B
authors.initials: VB
authors.lastname: Bittencourt
authors.forename: F
authors.initials: F
authors.lastname: Pires
authors.forename: E
authors.initials: E
authors.lastname: Didone
authors.forename: E
authors.initials: E
authors.lastname: Guerra
authors.forename: S P
authors.initials: SP
authors.lastname: Vitola
authors.forename: J
authors.initials: J
authors.lastname: Antonello
authors.forename: D
authors.initials: D
authors.lastname: Malheiros
authors.forename: A
authors.initials: A
authors.lastname: Tumelero
authors.forename: V D
authors.initials: VD
authors.lastname: Garcia
mesh_terms: D000328:Adult; D001938:Brazil; D002102:Cadaver; D002675:Child, Preschool; D005006:Ethnicity; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome