Clinical Experience of 60 Pediatric Renal Transplantations at a Single Center

Lee, Sun Youn; Han, Hyewon; Park, Young Seo; Han, Duck Jong

Abstract

PURPOSE
Renal transplantation for the management of end-stage renal disease(ESRD) in children is now the optimal treatment. We analyzed the clinical courses and characteristics of pediatric renal transplantation in Asan Medical Center.
METHODS
We reviewed the charts of 60 cases of renal transplantation under the age of 18, admitted to Asan Medical Center, from Oct. 1990 to May 2003. We analyzed retrospectively to clarify the clinical courses, risk factors affecting graft survival, recurrence of the original disease, complications and growth.
RESULTS
Graft was taken from 48 living donors, and 12 cadaveric donors. The mean age at transplantation was 13.1 years. The overall graft survival rates were 96.3% at one year, 84.4% at five year, 47.6% at 10 years. The overall patient survival rates were 98.1% at one year, 95.1% at five years, 95.1% at 10 years. A total of 13 grafts were lost(21.7%). The presence of acute rejection within one year after graft(P=0.0045) and recipient less than five years old(P=0.0027) were significant risk factors for poor graft survival. The recurrence rate of original disease was 8.3% and the most common complication was infection(50%). In the group less than 3 percentile of pretransplantation height, there were much longer duration of ESRD and much greater growth after transplantation(P=0.002).
CONCLUSION
The graft survival rate for pediatric renal transplantation has been greatly increased, similar to those of adult renal transplantation with the development of operation techniques and immunosuppressants. Further studies into the factors improving graft survival and new immunosuppressants to reduce the rate of rejection, and efforts to reduce the incidence of infection, are needed at this time.