Outcome of pediatric renal transplantation

Outcome of pediatric renal transplantation in Labfi Nejad
Hospital, Tehran, Iran

Abstract Kidney transplantation is the treatment of choice
for children with end-stage renal disease. In Iran, a kidney
transplantation program was started in the Labfi Nejad
Hospital, Tehran in 1985. From 1985 to 2003, 278 children
(mean age 11.6 years, 59.7% males) received their first
renal transplant. All transplants were donations from live
donors (12.5% live-related donors); 30.8% of patients were
preemptively transplanted. The overall 1-year patient
survival rate was 92% and the 5-year survival rate 74%.
The median graft survival time was 7.2 years. The rate of
graft survival was 88.8% at 1 year, 77% at 3 years, 67% at
5 years, 50% at 7 years, and 43% at 10 years after
transplantation. The survival rate of patients and transplants improved significantly with time (p<0.05). In
patients transplanted before 1997, the 5-year graft survival
was 50% and 82% in patients transplanted after 1997. At
the same time intervals, the frequency of acute rejection
episodes was 66.6 versus 40.8% and of chronic rejection
50.5 versus 28.7%. The outcome in children below the age
of 6 years was poor. Graft survival was negatively
correlated with the frequency and an early time point of
acute rejection episodes. The modus of transplantation
(preemptive or postdialysis) did not influence the results. In
conclusion, patient and graft survival in transplanted
children significantly improved with time, thus reflecting
greater medical and surgical experience, new immunosuppressive drugs, and better compliance.