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Byline: R. Dall'Amico (1), F. Ginevri (2), L. Ghio (3), L. Murer (1), F. Perfumo (2), G. F. Zanon (1), L. Berardinelli (4), G. Basile (2), A. Edefonti (3), R. Garavaglia (3), B. Damiani (3), U. Valente (5), I. Fontana (5), M. Bertipaglia (1), M. Cardillo (6), M. Scalamogna (6), G. Zacchello (1) Keywords: KeywordsaRenal transplantation; Rejection; Growth; Thrombosis; Immunosuppression; Infections Abstract: To evaluate the efficacy of renal transplan- tation in small pediatric patients, we have reviewed 41 allografts performed in 39 children (28 M/11 F) less than 6 years of age between 1987 and 1998 in the North Italy Transplant Program. Of these patients, 39 had a cadaver donor and 2 a living-related donor, with ages ranging from 20 days to 35 years. The mean follow-up was 56 months. Graft survival was 74.5% and 70.5% at 1 and 5 years, respectively. The causes of graft lost were acute rejection (4), graft vascular thrombosis (4), and hemolytic uremic syndrome recurrence (1). Only 1 patient has died due to chickenpox. Double and triple immunosuppressive therapies were used in 63% and 37% of patients, respectively, on the basis of different center protocols, without differences in graft survival. Steroids were successfully administered on alternate days in 37% of patients, 6--12 months after transplantation. Thrombosis was reported in 2 of 6 kidneys from donors less than 1 year of age and in 2 of 35 donors older than 1 year (P&lt 0.05). Thirty rejections occurred in 23 patients: 7 episodes were steroid resistant and were treated with ATG/OKT3. Thirty-four infections were reported in 16 of 41 patients of these 17 were viral, 14 bacterial, and 3 due to Mycoplasma. Four surgical complications were reported: 1 graft artery stenosis, 1 ureteral stenosis, 1 urinary leak, and 1 lymphocele. Mean height standard deviation score improved from --2.0+-1.3 pre transplantation to --1.8+-1.4, --1.5+-1.3, and --1.5+-1.5 at 1, 2, and 5 years post transplantation. Linear growth was significantly better in infants treated with alternate-day steroids. Hypertension was a frequent complication, since 19 of the 30 patients with a 5-year follow-up were still being treated with antihypertensive drugs. In conclusion, graft survival in patients less than 6 years old is satisfactory and similar to that obtained in children aged from 6 to 18 years (70.5% vs. 78.9% at 5 years, P=NS). Consequently, since there are many difficulties in managing infants on maintenance dialysis, an early transplant should be considered. Donors older than 24 months carry a low risk of vascular thrombosis and may be successfully grafted in infants. Author Affiliation: (1) Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy e-mail: roberto@child.pedi.unipd.it Tel.: +39-049-821-3505, Fax: +39-049-821-3509, IT (2) Department of Nephrology, Institute Gaslini, Genoa, Italy, IT (3) Department of Pediatrics, University of Milan, Milan, Italy, IT (4) Department of Vascular Surgery and Kidney Transplantation, Maggiore Hospital, Milan, Italy, IT (5) Department of Transplantation, S. Martino Hospital, University of Genoa, Genoa, Italy, IT (6) North Italia Transplant, Milan, Italy, IT Article note: Received: 10 December 1999 / Revised: 31 July 2000 / Accepted: 25 August 2000

To evaluate the efficacy of renal transplantation in small pediatric patients, we have reviewed 41 allografts performed in 39 children (28 M/11 F) less than 6 years of age between 1987 and 1998 in the North Italy Transplant Program. Of these patients, 39 had a cadaver donor and 2 a living-related donor, with ages ranging from 20 days to 35 years. The mean follow-up was 56 months. Graft survival was 74.5% and 70.5% at 1 and 5 years, respectively. The causes of graft lost were acute rejection (4), graft vascular thrombosis (4), and hemolytic uremic syndrome recurrence (1). Only 1 patient has died due to chickenpox. Double and triple immunosuppressive therapies were used in 63% and 37% of patients, respectively, on the basis of different center protocols, without differences in graft survival. Steroids were successfully administered on alternate days in 37% of patients, 6-12 months after transplantation. Thrombosis was reported in 2 of 6 kidneys from donors less than 1 year of age and in 2 of 35 donors older than 1 year (P<0.05). Thirty rejections occurred in 23 patients: 7 episodes were steroid resistant and were treated with ATG/OKT3. Thirty-four infections were reported in 16 of 41 patients; of these 17 were viral, 14 bacterial, and 3 due to Mycoplasma. Four surgical complications were reported: 1 graft artery stenosis, 1 ureteral stenosis, 1 urinary leak, and 1 lymphocele. Mean height standard deviation score improved from −2.0±1.3 pre transplantation to &minus1.8±1.4, −1.5±1.3, and −1.5±1.5 at 1, 2, and 5 years post transplantation. Linear growth was significantly better in infants treated with alternate-day steroids. Hypertension was a frequent complication, since 19 of the 30 patients with a 5-year follow-up were still being treated with antihypertensive drugs. In conclusion, graft survival in patients less than 6 years old is satisfactory and similar to that obtained in children aged from 6 to 18 years (70... [ABSTRACT FROM AUTHOR]