 |
|
A 100% 2-Year Graft Survival Can Be Attained in High-Risk 15-kg or Smaller Infant Recipients of Kidney Allografts
Maria T. Millan, MD;
Minnie M. Sarwal, MD, PhD;
Kevin V. Lemley, MD, PhD;
Peter Yorgin, MD;
Pamela Orlandi, RN;
Samuel So, MD;
Steven Alexander, MD;
Oscar Salvatierra, Jr, MD
Arch Surg. 2000;135:1063-1068.
Background Infants make up the most high-risk, difficult to care for subgroup undergoing kidney transplantation, with the lowest 1- and 2-year graft survival rates of any other age group. The principal causes of graft loss have been graft thrombosis, primary nonfunction, technical error, and irreversible acute rejection.
Hypothesis Infants undergoing kidney transplantation can achieve near 100% graft survival at 2 years following surgery, despite their very high-risk status.
Design Analysis of 45 consecutive kidney transplants performed in patients weighing less than or equal to 15 kg during an 8-year period beginning August 1991. Patients included complex referrals from throughout the United States and all received transplants and were cared for by the same pediatric kidney transplantation team.
Results Mean weight at transplantation was 11.2 kg. Renal failure was due to congenital or urologic causes in the majority (53%) of cases. Size-discrepant adult-sized kidney grafts were transplanted in 80% of patients; 64% received live-donor grafts; 78% were receiving dialysis prior to transplantation; and 27% had extremely small bladders (<20 cm3) requiring modification of the ureteral implantation. Excluding 1 transplant-unrelated death, graft and patient survival at 2 years was 100%. Eight-year patient and graft survival rates (for our combined live and cadaver donor series) were 89.6% and 84.6%, respectively. This compares favorably with much lower graft survival in low-risk adult recipients. Delayed graft function occurred in only 1 patient (2%). Rate of incidence of rejection was 9.3% within 2 years of transplantation and the overall rejection rate was 15.5%. No graft was lost to vascular thrombosis, primary nonfunction, technical error, or acute rejection. The mean creatinine level was 53.04 µmol/L (0.6 mg/dL) and 61.9 µmol/L (0.7 mg/dL) at 1 and 2 years, respectively, and 88.4 µmol/L (1.0 mg/dL) at 3, 4, and 5 years after transplantation.
Conclusion One hundred percent 2-year and excellent 8-year graft survival rates can be achieved in what has historically been the highest-risk and most difficult to care for patient subgroup undergoing kidney transplantation.
From the Department of Surgery, Stanford University Medical Center and the Lucile Packard Children's Hospital, Palo Alto, Calif.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Outcomes of Dialysis Initiated During the Neonatal Period for Treatment of End-Stage Renal Disease: A North American Pediatric Renal Trials and Collaborative Studies Special Analysis
Carey et al.
Pediatrics 2007;119:e468-e473.
ABSTRACT
| FULL TEXT
Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation
Knoll et al.
CMAJ 2005;173:S1-S25.
FULL TEXT
Neonatal Peritoneal Dialysis
Lee et al.
NeoReviews 2005;6:e384-e391.
FULL TEXT
Outcome of reaching end stage renal failure in children under 2 years of age
Coulthard and Crosier
Arch. Dis. Child. 2002;87:511-517.
ABSTRACT
| FULL TEXT
|
