Long-term outcome of paediatric renal transplantation: follow-up of 300 children from 1973 to 2000.
2007/8/5
Nephron Clin Pract. 2007;105(2):c68-76. Epub 2006 Nov 29.
Rees L, Shroff R, Hutchinson C, Fernando ON, Trompeter RS.
Department of Nephro-Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK. ReesL@gosh.nhs.uk
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. Copyright 2007 S. Karger AG, Basel.
PMID: 17135771 [PubMed - indexed for MEDLINE]