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| Living-related pediatric renal transplants: A single-center experience from a developing country |
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| Author(s): Rizvi SAH, Naqvi SAA, Hussain Z, Hashmi A, Akhtar F, Zafar MN, Hussain M, Ahmed E, Kazi JI, Hasan AS, Khalid R, Aziz S, Sultan S |
| Source: PEDIATRIC TRANSPLANTATION Volume: 6 Issue: 2 Pages: 101-110 Published: APR 2002 |
| Times Cited: 16 References: 36 |
| Abstract: We retrospectively analyzed the results of 75 living-related pediatric renal transplants performed at our center between January 1986 and December 1999. The major causes of end-stage renal disease (ESRD) were glomerulonephritis (26%) and nephrolithiasis (16%), while the etiology was unknown in 50%. The mean age of the recipients was 12 yr (range 6-17 yr) and that of the donors was 39 yr (range 20-65 yr). The majority (73%) of donors were parents. Eighty five per cent of donors were one-haplotype matched and the rest identical. Immunosuppression was based on a triple drug regimen. Thirty per cent of recipients were rapid metabolizers of cyclosporin A (CsA) (area under the curve [AUC] <6000 ng/mL/h), while 16%, were slow metabolizers (AUC: >8000 ng/mL/h). Forty three (57%) children encountered 59 rejection episodes, the majority of which (59%) were recorded in the first month post-transplant. Seventy-four per cent of the rejection episodes were steroid sensitive and the rest, except two, were resolved by therapy with antithymocyte globulin (ATG) or orthoclone thymocyte 3 (OKT3). After a mean follow-up of 37 months, 17 (22%) grafts had chronic rejection and 76% of these recipients had previously experienced acute rejection episodes. The overall infection rate was high, necessitating two hospital admissions/patient/year. The majority (53%) of the infections were bacterial. Urinary tract infections (UTIs) were seen in 17 (23%) recipients. Twelve of these had ESRD as a result of stone disease and eight grafts were lost because of UTIs. Eight per cent of recipients developed tuberculosis (TB), and extra-pulmonary lesions were seen in 50%. Surgical complications were encountered in eight patients. Free medication to all recipients and parental support ensured a compliance rate of 93%. Baseline growth deficit was seen in children of the two groups studied (the 6-12 yr and 13-17 yr age-groups), with Z-scores of -2.39 and -2.12, respectively. No catch-up growth was observed at 12 and 24 months in either group. Post-donation complications were seen most commonly in donors >50 yr of age and included: proteinuria (>300 mg/24 h, four patients), hypertension (three patients), and diabetes (one patient). Twenty-Four grafts were lost, 54% as a result of immunological and the rest as a result of non-immunological causes, and 17 recipients died during the follow-up period. Infections were the main cause of patient and graft loss. Overall 1- and 5-yr patient and graft survival rates were 90%, 75%, 88% and 65%, respectively. |
| Document Type: Article |
| Language: English |
| Reprint Address: Rizvi, SAH (reprint author), Dow Med Coll, Sindh Inst Urol & Transplantat, Karachi 74200, Pakistan |
Addresses:
1. Dow Med Coll, Sindh Inst Urol & Transplantat, Karachi 74200, Pakistan |
| Publisher: BLACKWELL MUNKSGAARD, 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK |
| Subject Category: Pediatrics; Transplantation |
| IDS Number: 552MF |
| ISSN: 1397-3142 |
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