Abstract
We analyzed the results of 165 pediatric cadaver renal transplants performed at the University of California at Los Angeles to identify the factors which are linked to improved allograft survival. Both univariate life-table analysis and the Cox proportional hazard model were used. The use of a sequential immunosuppressive regimen (P<0.001) and kidneys from of more than 6 years of age (P<0.001) were found to be the factors having the most influence on primary graft survival. The sequential regimen was the only factor favorably influencing retransplants. With sequential therapy 1- and 2-year actuarial graft survival rates were 94% and 91% in primary transplants, and 82% and 70% in retransplants. Medication noncompliance exerted a large negative effect on transplant outcome. Of 70 recipients who had been on cyclosporine for at least 6 months, 50% evidenced noncompliance. Sixty-four percent of adolescents were noncompliant. Thirteen percent of the recipients lost their graft because of noncompliance. We conclude that good results can be obtained with cadaver renal transplants in children with a sequential immunosuppressive regimen and the use of kidneys from adolescent and adult donors. Noncompliance is a great barrier to long-term success in pediatric transplantation.
Article PDF
Similar content being viewed by others
References
Offner G, Hoyer PF, Brodehl J (1987) Cyclosporine A in paediatric kidney transplantation. Pediatr Nephrol 1:125–130
Francis DMA, Miller RJ, Walker RG (1989) Cadaver renal transplantation in children using low dose triple immunosuppression. Transplant Proc 21:1696–1697
Ellis D, Avner ED, Rosenthal JT (1985) Renal function and somatic growth in pediatric cadaveric renal transplantation with cyclosporine-prednisone immunosuppression. Am J Dis Child 139: 1161–1167
MacDonald AS, Crocker JFS, Belitsky P (1986) Cyclosporine therapy in pediatric renal transplantation. Transplant Proc 18:153–155
North American Pediatric Renal Transplant Cooperative Study (1989) A report of the North American Pediatric, Renal Transplant Cooperative Study (abstract). Pediatr Nephrol 3:C223
Neiberger R, Weiss R, Gomez M (1987) Elimination kinetics of cyclosporine following oral administration to children with renal transplants. Transplant Proc 19:1525
Canadian Multicenter Transplant Study Group (1983) A randomized clinical trial of cyclosporine in cadaveric renal transplantation. N Engl J Med 309:809–815
Ettenger RB, Blifeld C, Price H (1987) The pediatric nephrologist's dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr 111:1022–1025
Hoyer PF, Offner G, Brodehl J (1989), Renal function and donor age: five years experience with cyclosporine A. Transplant Proc 21: 1930–1931
Arbus GS, Rochon J, Thompson D (1989) First cadaveric renal transplant graft survivals from young donors or to young recipients in a single pediatric center (abstract). Eighth Annual Meeting of the American Society of Transplant Physicians, Chicago, Ill., May 1989, pp 71
Rovelli M, Palmeri D, Vorsler E (1989) Noncompliance in organ transplant recipients. Transplant Proc 21:833–834
Sommer B, Ferguson R (1985) Three immediate post-renal transplant adjunct protocols combined with maintenance cyclosporine. Transplant Proc 17:1235–1238
Uittenbogaart CH, Robinson B, Malekzadeh MM (1980) Pretransplant T cell levels and renal allograft survival. Surgery 87:432–435
Kerman RH, Floyd M, Payne W (1983) Monitoring of T cell subsets and immune events in renal allograft recipients. Transplant Proc 15: 1170–1172
Drachman R, Schlesinger M, Shapira H, Druckker A (1989) The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy. Pediatr Nephrol 3:305–308
Ettenger RB, Rosenthal JT, Marik J (1989) Successful cadaveric renal transplantation in infants and young children. Transplant Proc 21:1707–1708
Tejani A, Butt KMH, Khawar (1986) Cyclosporine exprience in renal transplantation in children. Kidney Int 30:S35-S43
Hoyer PF, Offner G, Wonigeit K (1984) Dosage of cyclosporine A in children with renal transplants. Clin Nephrol 22:68–71
Balfour HH, Chace BA, Stapleton JT (1989) A randomized placebocontrolled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts N Engl J Med 320: 1381–1387
Snydman DR, Werner BG, Heinze-Lacey B (1989) Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N Engl J Med 317:1049–1054
Ettenger RB, Marik J, Rosenthal JT (1988) OKT3 for rejection reversal in pediatric renal transplantation. Clin Transplant 2: 180–184
Beck DE, Fennell RS, Yost RL (1980) Evaluation of an educational program on compliance with medication regimens in pediatric patients with renal transplants. J Pediatr 96:1094
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ettenger, R.B., Rosenthal, J.T., Marik, J.L. et al. Improved cadaveric renal transplant outcome in children. Pediatr Nephrol 5, 137–142 (1991). https://doi.org/10.1007/BF00852871
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00852871