Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000

Abstract

Background/Aim: 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.

Renal Replacement Therapy in Infants with Chronic Renal Failure in the First Year of Life

“…Furthermore, Najarian et al (22,27) found no difference in patient or graft survival between children aged Ͻ1, 1 to 2, and 2 to 5 yr. More recent analyses showed equivalent results in age groups Ͻ1, 1 to 4, and 5 to 13 yr (28). Rees et al (29) documented that the outcome of successful transplantation was unaffected by age at time of transplantation. The survival of living-related donor transplants was superior to deceased-donor transplants for the first 5 yr.…”

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“…4 Very young recipient age was associated with poorer short-term graft survival, probably because of greater A B technical complexity and higher incidence of vascular thrombosis and acute cellular and vascular rejection in this group. 14 The 1-and 5-year graft survival for the present patients were comparable to reported outcomes from the Collaborative Transplant Study registry (Figure 2).…”

“…16 The frequency of living donation varies in different regions including North America (60%), United Kingdom (25%), and Germany (18%), possibly because of variation in cultural and social attitudes and features of donation in the transplant programs. 4,17,18 Donor nephrectomy was performed laparoscopically in 445 transplants (90%). Previous randomized and nonrandomized studies in adults showed that laparoscopic donor nephrectomy is associated with longer operative and warm ischemia times but lower duration of hospitalization and analgesic requirements than open nephrectomy.…”

“…Most transplant centers report that approximately two-thirds of children and adolescents in ESRD programs have a transplant. 4,5 Follow-up studies of survival for 20 years have been published. 6,7 We previously presented a randomized controlled study that compared open and laparoscopic donor nephrectomy in children and adults.…”

Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt

“…The authors reported that the degree of improvement in LV contractility after transplantation was a 56% increase in fractional shortening, and it was larger than that expected for correction of anemia [27]. Reduction of the LVMI after renal transplantation has not been a universal observation; more recent studies did not find significant change in LVMI following transplantation [28], and Mitsnefes et al [9] showed that there was no significant difference in the mean values for the LVMI in children and adolescents while on dialysis and after renal transplantation. Bullington et al reported in a cross-sectional study that LVH is a known cardiovascular risk factor that is frequent in children after kidney transplantation.…”