This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (4)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pediatric Surgery  • Kidney Transplantation  • Immunology  • Immunology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Patrick J. Healey, MD; Ruth McDonald, MD; John H. T. Waldhausen, MD; Robert Sawin, MD; David Tapper, MD

Arch Surg. 2000;135:1035-1041.

Hypothesis  We hypothesized that improved outcomes following renal transplantation in high-risk infants and small children primarily are due to advances in immunosuppression and accurate diagnosis of rejection. Optimizing renal allograft perfusion is critical to achieving good early graft function and decreasing early graft loss.

Design  Twenty-eight consecutive recipients (weighing <20 kg) of adult living donor kidneys transplanted at our center from 1984 to 1999 were reviewed. Two groups were identified based on differing immunosuppression protocols and clinical surveillance. Actuarial graft and patient survival reported at 1, 3, and 5 years were compared for group 1 (1984-1991) and group 2 (1992-1999). Graft losses, categorized as immunologic or nonimmunologic, and the incidences of delayed graft function, vascular thrombosis, and rejection were compared.

Results  Graft and patient survival in group 1 (n = 13) at 1, 3, and 5 years was 77% and 92%, 54% and 85%, and 54% and 85%, respectively. In group 2, all 15 patients are alive with functioning grafts to date. Immunologic graft loss occurred in 5 of 13 patients in group 1 who developed chronic rejection. Nonimmunologic causes (vascular thrombosis [2 patients]) and patient death [1]) resulted in early graft failure within 2 weeks in 3 of 13 patients in group 1. The overall incidences of delayed graft function (10.7%) and thrombosis (7.1%) were low and did not differ between groups. Percutaneous renal biopsy was used more frequently in group 2 to evaluate graft dysfunction and guide treatment.

Conclusions  We conclude that improved overall graft and patient survival in group 2 is owing to advances in immunosuppression and better treatment of rejection. Percutaneous renal biopsy allows prompt and accurate histological diagnosis of graft dysfunction. Surgical technique and aggressive fluid management aimed at maximizing renal allograft perfusion is critical in optimizing early graft function and decreasing vascular complications.

From the Department of Surgery (Drs Healey, Waldhausen, Sawin, and Tapper) and Division of Pediatric Nephrology (Dr McDonald), Children's Hospital and Regional Medical Center, University of Washington, Seattle.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?