Pediatric renal transplantation: a single center experience
Keywords:pediatric renal transplantation, end-stage renal disease, graft survival
Introduction: End-stage renal disease in children is associated with numerous comorbidities and with age-specific mortality rates approximately 30 times higher than in healthy children. The first kidney transplantation in children was performed successfully in 1954. Surgical advances and new immunosuppressive medications have greatly improved patient’s and graft’s survival in the last years.
Aim: Report Centro Hospitalar do Porto experience in pediatric renal transplantation in the last 30 years.
Methods: Epidemiological and clinical data of all patients younger than 18 years, transplanted between January 1984 and August 2013, were collected from our database. In order to analyze the transplantation outcome in our center we compare graft survival between decades (1984-89 / 1990-99 / 2000-09 / 2010-13). We also compare graft survival between two age groups of patients (0-10 years ; 11-17 years) at the time of surgery.
Results: One hundred thirty-nine patients (58.3% male) underwent 147 renal transplants (6.8% live donors). Congenital anomalies of the kidney and urinary tract (56.5%) and glomerulonephritis (18.4%) were the major causes of renal disease. Uncensored graft survivals rates at 5, 10, 15 and 20 years were 84.7%, 71.1%, 60.0% and 51.0%, while patient survivals were 97.9%, 95.9%, 94.7% and 94.7% respectively. Graft survival improved over time and the difference between the decades was statistically significant (p=0.004). Despite the better survival in the group of patients older than 11 years, graft’s survival difference between the two age groups was not statistically significant (p=0.697).
Conclusion: The results of our hospital are comparable to other international centers. Significant improvement in survival was observed over the time. It seems that an accurate follow-up of our patients helps to minimize the negative impact of adolescence on graft survival rates.
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