KC Tse, MC Chiu, WM Lai, Sc Lau

Abstract

Successful renal transplantation is the best renal replacement therapy for children with end stage renal disease. In the present study, we reviewed our experience with renal transplanted children currently managed in our Department. There were 20 transplants done in 19 Chinese children from 4/1992 to 2/2002. The most common cause of renal failure was renal dysplasia (27%) followed by focal segmental glomerulosclerosis (FSGS) (16%). Seven allografts came from living donors and 13 were from cadaveric donors. Three children underwent pre-emptive transplantation. The mean waiting time for local cadaveric kidney was 4.4 ± 2.3 years. Mean age at transplantation was 15.3 ± 4.5 years and the mean duration of follow-up was 2.4 ± 2.4 years. Immunosuppressive protocol consisted mainly of triple therapy with prednisolone, azathioprine/mycophenolate mofeteil, and neoral/FK506. Lamivudine was used in 5 children with chronic HBV infection with no flare-up of the infection at the last follow-up and with good tolerance of the drug. There was no case of CMV infection. Acute rejection occurred in 5 allografts (25%); and chronic rejection occurred in 4 allografts (20%). There were 3 graft loss (15%) due to resistant acute rejection, chronic rejection and recurrence of the original renal disease respectively. Actuarial graft survival rate at 1 year and 3 years post-transplantation were 100 % for living donor kidney and those for cadaveric donor kidney at 1 year and 3 years were 92.3% and 83.1% respectively. The mean GFR was 71.8 ± 17.2 ml/min/1.73 m². Actuarial patient survival rate was 100%. Most of them were able to go back to school or be employed. In conclusion, good short-term graft survival rate and excellent patient survival rate had been achieved with kidney transplantation in children in our Center. Chronic allograft nephropathy and recurrence of the original renal disease remained the major problems to long-term graft survival. Lamivudine might make transplantation feasible in those chronic HBV infected ESRD patients.