A single center experience with renal transplantation in young children

Results of pediatric renal transplantation have been variable. We evaluated our experience with renal transplantation in children less than 5 years old to determine its safety and efficacy. Of the 428 renal transplants done at our institution from August 1983 to December 1989, 14 were performed in 13 children 13 to 50 months old (mean age 34 months). All of the patients were small for age with height standard deviation scores ranging from -1.7 to -4.5. Patient survival, allograft survival and statural growth were used as determinants of successful outcome. Followup was complete in all patients, including renal function studies and serial height measurements. Growth velocity standard deviation scores were calculated. Patient survival was 100%. Allograft survival was 100% 2 to 7.3 years after transplantation for living related donor recipients whereas 1-year graft survival was poor (40%) for cadaveric graft recipients. Of 10 patients with good graft function at 1 year 9 demonstrated improvement in the height standard deviation score. Seven of 10 patients demonstrated significant catch-up growth (growth velocity standard deviation score greater than 0, p = 0.04). Our study supports the safety and efficacy of renal transplantation in young children. Early transplantation using living-related donor organs is the optimal therapy to prevent growth retardation and allow the young child with end stage renal disease to have a normal life.