Renal transplantation in infants

Although kidney transplants have been performed for many years, there is controversy over the advisability of this procedure for young children with kidney failure or end-stage renal disease. Kidney failure in infants is associated not only with growth failure, but also with severe central nervous system disorders including progressive encephalopathy (abnormal structure or function of brain tissue), delayed development, microcephaly (small brain size) and seizures. If these infants are to survive and develop, they need early and aggressive intervention. Results are reported from the authors' experience in treating 75 infants less than two years old with kidney transplantation; 79 transplants were performed in these children. In 63 transplant operations, the donor was a living relative of the baby; 1 was not related; and 15 organs were obtained from cadavers (dead bodies). All the infants who received transplants were on or about to begin hemodialysis (a procedure in which wastes are removed from the blood using a machine). The transplants took place between 1965 and 1989, and 64 percent of the patients are alive with functioning kidneys. Since 1983, the one-year patient survival has been 95 percent, and the five-year survival has been 91 percent. Survival of the graft (donated organ) has been 86 percent at one year and 73 percent at five years. Patients who received immunosuppressive therapy with cyclosporine had 100 percent patient survival at one and five years, with graft survival of 96 percent at one year and 82 percent at five years. There was no difference in outcome between infants and older children. The most common cause of graft loss was rejection of the donated organ (15 patients). No graft rejection episode has been experienced by 52 percent of the transplant patients. Following transplantation, infant growth and development improved. It is recommended that living donors be used whenever possible. (Consumer Summary produced by Reliance Medical Information, Inc.)