title: Long-term critical issues in pediatric renal transplant recipients: a single-center experience.
abstract: Data on long-term outcomes after pediatric renal transplantation (Tx) are still limited. We report on a 20-year single-center experience. Medical charts of all consecutive pediatric Tx performed between 1987 and 2007 were reviewed. Data of patients who had been transferred to adult units were extracted from the French databases of renal replacement therapies. Outcomes were assessed using Kaplan-Meier and Cox models. Two hundred forty Tx were performed in 219 children (24.1% pre-emptive and 17.5% living related donor Tx). Median age at Tx was 11.1 years and median follow-up was 10.4 years. Patient survival was 94%, 92%, and 91% at 5, 10, and 15 years post-Tx, respectively. Overall, transplant survival was 92%, 82%, 72%, and 59% at 1, 5, 10, and 15 years post-Tx, respectively. The expected death-censored graft half-life was 20 years. Sixteen patients developed malignancies during follow-up. Median height at 18 years of age was 166 cm in boys and 152 cm in girls with 68% of patients being in the normal range. The proportion of socially disadvantaged young people was higher than in general population. Excellent long-term outcomes can be achieved in pediatric renal Tx, but specific problems such as malignancies, growth, and social outcome remain challenging.
authors.affiliation: Service de Néphrologie et Rhumatologie Pédiatrique, Centre de référence des maladies rénales rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Harambat
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
authors.forename: Aurélia
authors.initials: A
authors.lastname: Bertholet-Thomas
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mestrallet
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: Odile
authors.initials: O
authors.lastname: Basmaison
authors.forename: Raymonde
authors.initials: R
authors.lastname: Bouvier
authors.forename: Delphine
authors.initials: D
authors.lastname: Demède
authors.forename: Laurence
authors.initials: L
authors.lastname: Dubourg
authors.forename: Daniel
authors.initials: D
authors.lastname: Floret
authors.forename: Xavier
authors.initials: X
authors.lastname: Martin
authors.forename: Pierre
authors.initials: P
authors.lastname: Cochat
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D015233:Models, Statistical; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents