Improving results of pediatric renal transplantation

Shapiro, R and Tzakis, A and Scantlebury, V and Jordan, M and Vivas, C and Ellis, D and Gilboa, N and Irish, W and Hopp, L and Reyes, J and Hakala, TR and Simmons, RL and Starzl, TE (1994) Improving results of pediatric renal transplantation. Journal of the American College of Surgeons, 179 (4). 424 - 432. ISSN 1072-7515

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Abstract

BACKGROUND: Outcome after renal transplantation in children has been variable. We undertook a retrospective study of our experience over the past five years. STUDY DESIGN: From January 1, 1988, to October 15, 1992, 60 renal transplantations were performed upon 59 children at the Children's Hospital of Pittsburgh. Twenty-eight (47 percent) of the kidneys were from cadaveric donors, and 32 (53 percent) were from living donors. The recipients ranged in age from 0.8 to 17.4 years, with a mean of 9.8 ± 4.8 years. Forty-six (77 percent) recipients were undergoing a first transplant, while 14 (23 percent) received a second or third transplant. Eight (13 percent) of the patients were sensitized, with a panel reactive antibody of more than 40 percent. Eleven of the 14 patients undergoing retransplantation and seven of the eight patients who were sensitized received kidneys from cadaveric donors. Thirty- three (55 percent) patients received cyclosporine-based immunosuppression, and 27 (45 percent) received FK506 as the primary immunosuppressive agent. RESULTS: The median follow-up period was 36 months, with a range of six to 63 months. The one- and four-year actuarial patient survival rate was 100 and 98 percent. The one- and four-year actuarial graft survival rate was 98 and 83 percent. For living donor recipients, the one- and four-year actuarial patient survival rate was 100 and 100 percent; for cadaveric recipients, it was 100 and 96 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 95 percent for the living donor recipients and 96 and 69 percent for the cadaveric recipients. Patients on cyclosporine had a one- and four-year patient survival rate of 100 and 97 percent, and patients on FK506 had a one- and three-year patient survival rate of 100 and 100 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 85 percent in the cyclosporine group, while one- and three-year actuarial graft survival rates were 96 and 84 percent in the FK506 group. The mean serum creatinine level was 1.24 ± 0.64 mg per dL; the blood urea nitrogen level was 26 ± 13 mg per dL. The incidence of rejection was 47 percent; 75 percent of the rejections were steroid-responsive. The incidence of cytomegalovirus was 10 percent. The incidence of post-transplant lymphoproliferative disorder was 8 percent. None of the patients on cyclosporine were able to be taken off prednisone; 56 percent of the patients receiving FK506 were taken off prednisone successfully. Early growth and development data suggest that the patients receiving FK506 off prednisone had significant gains in growth. CONCLUSIONS: These results support the idea that renal transplantation is a successful therapy for end-stage renal disease in children. They also illustrate the potential benefits of a new immunosuppressive agent, FK506.

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Details

Item Type:	Article
Status:	Published
Creators/Authors:	Creators Email Pitt Username ORCID Shapiro, R Tzakis, A Scantlebury, V Jordan, M Vivas, C Ellis, D Gilboa, N Irish, W Hopp, L Reyes, J Hakala, TR Simmons, RL Starzl, TE tes11@pitt.edu TES11
Centers:	Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date:	18 October 1994
Date Type:	Publication
Journal or Publication Title:	Journal of the American College of Surgeons
Volume:	179
Number:	4
Page Range:	424 - 432
Institution:	University of Pittsburgh
Refereed:	Yes
ISSN:	1072-7515
Other ID:	uls-drl:31735062126200, Starzl CV No. 1764
Date Deposited:	08 Apr 2010 17:30
Last Modified:	04 Feb 2019 15:58
URI:	http://d-scholarship.pitt.edu/id/eprint/5150

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