Renal Transplantation in Korean Children: Cooperative study

Kim, Pyung Kil

Abstract

Renal transplantation is the optimal therapy for children with end-stage renal disease. A successful renal transplantation allows normal growth and development and enables children to return to normal lifestyle. The graft survival rate for renal transplantation has been greatly increased with the developments in immunology, operation techniques, and with the use of effective immunosuppressants. We analyzed retrospectively the results of renal transplantation in Korean children, who were under 19 years of age at the time of renal transplantation. Data were collected from 11 hospitals where pediatric renal transplantations were performed. 181 pediatric renal transplantations were performed from July, 1973 to Aug., 1994. There were 121 male and 60 female recipients. The mean age was 14.2+/-3.6 years (mean+/-SD) and the youngest was 2 years old at the time of transplantation. All donors except two were living donors and among them, living-related donors were 136(75.1%) and living-unrelated donors were 43(23.8%). The most common causes of end-stage renal disease were chronic glomerulonephritis 35 cases(19.3%), reflux nephropathy 25 cases(13.8%), focal segmental glomerulosclerosis 24 cases(13.2%), IgA nephropathy 11 cases(6%), and Alport's syndrome 9 cases(5%). Overall patient and graft survival rates were 96.1% and 93% at 1 year, 91.8% and 70% at 5 year, respectively. ABO matching was a significant risk factor affecting graft survival rate; 1 and 5 year graft survival rate was 93.8% and 75.1% in ABO identical group, when compared to 89.6% and 47.7% in ABO compatible group. Five year graft survival rate by the renal replacement modality prior to renal transplantation was 79% in no renal replacement prior to renal transplantation(preemptive) group, as compared to 51% in continuous ambulatory peritoneal dialysis group, showed a significant difference. There was no significant difference in graft survival rate by the source of donor, HLA compatibility, or immunosuppressants. Of the 181 grafts, 37(20.4%) showed graft failure. Twenty-two(59.5%) of these graft failures were caused by chronic rejection. Complications of operation occurred in 10 cases(5.5%). And complications of immunosuppressants occurred in 53 cases(29.3%). Finaly, vigorous attempts should be made to perform renal transplantation as early as possible at the diagnosis of end-stage renal disease to achieve proper development and prevention of growth retardation.