Nineteen-year experience of paediatric renal transplantation in Singapore.
BACKGROUND
Renal transplantation is the treatment of choice for children with end-stage renal failure (ESRF). The paediatric renal transplant programme in Singapore was initiated in 1989. This study aimed to examine our outcomes over the 19-year period from 1989 to 2007.


METHODS
A total of 38 renal transplants were performed at our centre. Another 4 patients with overseas transplants who returned within 3 weeks post-transplant were included. The proportion of living donor (LD) transplants was 61.9%. Structural abnormalities and glomerulopathies were the most common aetiologies comprising 33% each. Median age at transplant was 13.9 years and median waiting time was 2.2 years. LD transplant recipients were younger and had a shorter waiting time than deceased donor (DD) recipients.


RESULTS
Overall patient survival rates were 95%, 92%, 86% and 86% at 1, 5, 10 and 15 years, respectively. There were 4 deaths, of which 3 were due to infections. Graft survival rates at 1, 5, 10 and 15 years for LD and DD transplants were 100%, 89.5%, 67.3%, 67.3% and 80.8%, 56.5%, 42.2%, 28.3% respectively, and were significantly higher in LD transplants. The main cause of graft loss was rejection following non-adherence. Multivariate analysis showed male gender, late acute rejections and acute tubular necrosis as predictors of graft failure. There was a high incidence of early bacterial infections (42.9%) and cytomegalovirus disease (16.7%).


CONCLUSIONS
Our graft survival rates for LD transplants were comparable to North American rates, although our DD transplant rates were slightly worse, probably a reflection of the prevailing transplant policies.
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Kar Hui
KH
Ng
Pramod
P
Shrestha
Eric
E
Aragon
Yew Weng
YW
Lau
Wee Song
WS
Yeo
Yiong Huak
YH
Chan
Prabhakaran
P
Krishnan
Hui Kim
HK
Yap
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult