Renal transplantation: experience in Australia.

OBJECTIVE: Outcome of renal transplantation in children under the age of 15 years, who received a renal allograft at The New Children's Hospital between January 1983 to June 1997 was studied.
METHODS: Retrospective review of patients records and access to data collected from Renal Registry of the Hospital. 64 renal transplants were undertaken in 57 children during this period. Prednisone and Azathioprine were the mainstay of the immunosuppressive regimen up to 1983, then Cyclosporine A was introduced. Median age of first grafts was 10 years (range 1 month-14 years). There were 41 living related and 23 cadaveric grafts. 37 (64%) children had a congenital disorder as the cause of renal failure. Among them 14 (37%) had congenital renal dysplasia/hypoplasia, 20 (36%) had primary glomerular disorder as the cause of renal failure.
RESULTS: Survival analysis at 12 month, 5 yr and 10 yr showed functioning grafts in 85%, 67% and 64% case respectively. Longest surviving transplant was 14 years. 6 children had died. Cumulative patient survival was 92.9% at 1 year, 90% at 5 year and 87% at 10 year. Sixteen primary grafts were lost with most common cause being chronic rejection accounting for 68% of all transplant lost. Recurrence of primary disease was the second most common cause of graft failure. There was one malignancy in this series. 25 of the 29 children of school age with functioning transplant attended school full time in a class appropriate for their age and nine of 13 years older patients were working full time, two worked part time.
CONCLUSION: Renal transplantation is a successful treatment of end stage renal failure in children with high survival and normally functioning life. Chronic rejection remains a major cause of graft loss.