KIDNEY TRANSPLANTATION IN CHILDREN: RESULTS OF TEN YEARS EXP ERIENCE IN IMAM REZA HOSPITAL

Advances in nephrology and pediatric urology have increased the number of children who survive renal disease and become candidates for renal transplantation. Ten years of experience in pediatric renal transplantation are reviewed to determine the rates of patient morbidity and graft survival. Of the 450 renal transplantations performed in Imam Reza Hospital (1989- 1999), fifty-one were done on children (6-18yrs.). Causes of renal failure included: reflux nephropathy, 8 cases neurogenic bladder, 5 cases posterior urethral valve, one case prune belly syndrome, 1 case small kidney due to chronic glomerulonephritis, 8 cases the remaining failures were of unknown etiology. All kidneys were harvested from living donors,3o related and unrelated.20 Immunosuppressive therapy was given with three drugs in all children: prednisolone, azathioprine, and cyclosporine, with the exception of 6 recipients of HLA identical siblings who did not receive cyclosporine. The Kaplan-Meier curve was constructed to assess graft and patient survival and the Log rank test was used to assess the effect of kidney source and date of renal transplant. Immediate dieresis occurred in all graft. Surgical complications included two urinary fistulae and one clinical lymphocele which were all repaired surgically. There were eleven acute rejections. The most common causes of graft failure were chronic rejection and recurrence of primary renal diseases. The graft survival rates after 1, 2, 5 and 10 years were 95%, 84%, 76%, and 62% respectively. By all measures, renal transplantation is still the treatment of choice for children with ESRD. Renal transplantation in children results in improvement in physical growth, mental development and rate of survival. Hypertension, chronic rejection, infection, obesity and medical noncompliance continue to be problematic.