Factors Affecting Graft Survival in 111 Pediatric(<20yr) Renal Transplantation

Kim, Sang Joon; Jung, In Mok; Kim, Min Young; Lee, Tae Seung; Ha, Jong Won; Cheong, Hae Il; Choi, Yong

Abstract

Renal transplantation is the optimal treatment for children with end-stage renal disease. While it is largely recognized that improvements in immunosuppressive management, technical advances, and improved long-term care have had beneficial impacts on pediatric renal transplant outcome, graft survival of pediatric renal transplants is inferior to that of adult renal transplants. In order to investigate factors affecting graft survival and to devise better strategies for successful pediatric renal transplant outcome, a retrospective study was conducted. One hundred and eleven renal allografts(LRD:80, LUD:20, CAD:11) were transplanted to 111 pediatric ESRD patients under the age of 20 during the period between July, 1979 and June, 1997. Male to female ratio was 77:34. Mean duration of follow up was 55.9 months. Mean age at transplantation was 12.9 yrs. including 24 patients under the age of 10. Thirty one acute rejection episodes in 25 patients(22.5%) and 24 chronic rejections(21.6%) developed. Original diseases recurred in 12 patients, especially, 8/19 in focal segmental glomerular sclerosis(FSGS). Twenty three grafts were lost(20.7%) due to 18 chronic rejections, 3 recurrences of the original renal disease and 2 patient deaths with functioning graft. Overall 1, 3, 5, 10yr graft and patient survival rates were 94.3%, 86.3%, 76.3%, 62.5% and 98.2%, 96.1%, 94.0%, 94.0%, respectively. In univariate analysis, presence of acute rejection(p=0.012), posttransplant 1 week serum creatinine>or=2.5mg/dL(p=0.022), and LUD (p=0.028) were significant risk factors for poor graft survival. In multivariate analysis, presence of acute rejection(p=0.024) and LUD(p=0.027) were the poor prognostic factors for graft survival. In conclusion, improvement in graft survival of pediatric renal transplantation can be achieved by early detection and aggressive management of acute rejection and preferred selection of related donor in living donor kidney transplantation.