Outcome of cadaver kidney transplantation in small children

Abstract

Small children have often been reported to have poor outcome after kidney transplantation (KT). Recent reports from North America have shown that the use of living-related donors improves patient and graft survival. We report the experience in one centre of primary cadaveric KT using sequential immunosuppression in nine children aged 8-30 months and weighing 5.4-9.8 kg; donors were 0.7-12.3 years old. Four patients had pre-emptive KT and the other five were on peritoneal dialysis; the mean +/- SD waiting time was 2.0 +/- 2.4 months. Perioperative care has been published previously. The surgical approach was intraperitoneal if the aorta and vena cava were used (n = 7) and extraperitoneal for common iliac vessels anastomosis (n = 2); the duration of surgery was 3.5 +/- 0.9 h and the time for vascular anastomosis was 32 +/- 6 min. The recipients received ATG, azathioprine, prednisone and delayed administration of cyclosporin A. The patients were followed for 12-98 (median 41) months and showed good graft function (inulin clearance 63-100 ml/min/1.73 m2); only one child with recurrent haemolytic uraemic syndrome lost his graft three months post-transplantation and died after he had received a second graft. None of the recipients required post-transplant dialysis; arterial hypertension involved four children and was related to graft artery stenosis in two. Growth improved by 0.24 +/- 0.48 SD score of height per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Ask the expert

“…We believe that our data support those of Gellermann et al [1] in suggesting that ABPM on pre-school children is feasible, and therefore may become a useful tool in this age group. The potential of the technique cannot however be fully realised in the absence of reliable normative data.…”

“…The potential of the technique cannot however be fully realised in the absence of reliable normative data. Further studies are needed to test our observations and those of Gellermann et al [1] in other preschool children and to generate age-specific population data.…”

“…Side effects include bone marrow suppression and lymphoproliferative disease. The literature has a number of well-documented adult and pediatric cases with recurrence of TMA after transplantation treated with AZA, CsA, and OKT3 [1][2][3][4][5][6]. So, why not with ATG?…”

Outcome of preemptive renal transplantation and pretransplantation dialysis in children

“…All the recipients received rabbit anti-thymocyte globulins, azathioprine, prednisone, and delayed cyclosporin A [7].…”

Recent developments in the management of infants with end-stage renal disease

“…42-44,47,4s Cochat et al reported that infants who received cadaveric grafts obtained as good a result as those with living-related donors. 49 In most centers, early graft losses due to patient death were the largest risk factor in both patients and graft survival. If early graft loss due to death was not calculated in the survival data, the patient and graft survival rates for infants would be better than those for older age groups.…”