Long-Term Outcome Of Paediatric Renal Transplantation: Follow-Up Of 300 Children From 1973 To 2000

Rees, et al from the Great Ormond Street Hospital for Children and the Royal Free Hospital in London report their experience of paediatric renal transplantation from the beginning of their program.

They retrospectively reviewed patient and transplant survival and influencing factors in the 300 children transplanted between 1973-2000. The group found that 300 children have received a total of 354 transplantations. Fifty-six were living related donations. The median age at transplantation was 10.3 years. Forty-four percent had congenital structural abnormalities of the urinary tract. Forty-six children required a second and 8 required a third transplantation. The overall patients survival at 5, 10 and 20 years was 97, 94 and 72% respectively. In the overall cohort, the donor type did not affect mortality, nor did age at transplantation. However, those transplanted before 5 years of age had a significantly shorter post-transplant survival time. Transplant survival after the first transplant for deceased and living-related donors was 66 and 87% at 5 years, 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, in the most recent cohort between 1990-2000, age did not affect the outcome. They performed a multiple regression analysis and found that the only predictor of transplant survival was the era of transplantation. The median final height was within the normal range for males and females. Seven patients required growth hormone after transplantation. The group concluded that the outlook for successful transplantation is improving, especially in the last decade where age did not affect the success of transplantation. The group stated that survival of living related donor transplants is superior to cadaveric transplants for the first 5 years. They feel that they can predict that a 10 year old child receiving a transplant in 2000 also on cyclosporin-based immunosuppression can expect a transplant half-life of approximately 13.1 years from a living-related donor and one of 10.8 tears from cadaveric transplantation. These are very promising results which will require further investigation and warrant future updating.(Source: Great Ormond Street Hospital for Children : January 2007.)