MC Chiu

Abstract

Renal transplantation has developed to become the best renal replacement therapy for end-stage renal disease (ESRD) children. And in recent years, there are reports of good results even in infants. Currently, different programmes of enhancing cadaver kidney donation are conducted, and an alternative source comes from living donors of which parents are the main source. Cyclosporin has been used as the main immunosuppressant after transplant since the eighties, and in recent years, Mycophenolate Mofetil (MMF), and Tacrolimus (OKT3) are producing promising long term results. Anti-interleukin 2 receptor antibodies and sirolimus have also been shown to reduce early acute rejections. From the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), graft survival of recipients below 1 year old have worst results, and those above 12 years also do not do well after a few years which might be related to drug non-compliance. Living grafts are having better results than cadaver. The main causes of graft loss are graft vascular thrombosis, rejections and recurrence of original disease. Chronic graft rejection or allograft nephropathy is the main reason for long term graft failure. The experience of paediatric kidney transplant at Princess Margaret Hospital is shared, and the good results are considered to be related to the small number of transplants that have been done in small children and infants.