Original Paper

Long-Term Outcome of Paediatric Renal Transplantation: Follow-Up of 300 Children from 1973 to 2000
Lesley Rees^a, Rukshana Shroff^a, Carol Hutchinson^a, Oswald N. Fernando^b, Richard S. Trompeter<sup>a

a</sup>Department of Nephro-Urology, Great Ormond Street Hospital for Children NHS Trust, London, and
^bDepartment of Transplantation, Royal Free Hospital, London, UK

Address of Corresponding Author

Nephron Clin Pract 2007;105:c68-c76 (DOI: 10.1159/000097601)

  Key Words

• Renal transplantation
• Renal replacement therapy
• Mortality, renal transplantation
• Transplant survival
• Living-related kidney donation

  Abstract

Background/Aim: To report our experience of paediatric renal transplantation at Great Ormond Street and Royal Free Hospitals since the inception of the programme. Methods: Retrospective review of the patient and transplant survival and influencing factors in the 300 children transplanted between 1973 and 2000. Results: 300 children had received a total of 354 transplants; 56 were living-related donations. The median age at transplantation was 10.3 (range 1.4-17.9) years. Forty-four percent had congenital structural abnormalities of the urinary tract. Forty-six children required a second and 8 a third transplant before transfer to an adult unit. The overall patient survival at 5, 10, and 20 years was 97, 94, and 72%, respectively. In the overall cohort, the donor type (deceased donor or living-related donor) did not affect mortality, nor did age at transplantation, but those transplanted before 5 years of age had a significantly shorter post-transplant survival time (p < 0.0001). Transplant survival (first transplant) for deceased and living-related donors was 66 and 87% at 5 years (p < 0.01), 51 and 54% at 10 years, and 36% at 20 years (deceased-donor transplants only). Although the overall transplant survival was inferior in children transplanted before 2 years of age (p < 0.03), in the most recent cohort (1990-2000), age did not affect the outcome. On multiple regression analysis, the only predictor of transplant survival was the era of transplantation (p < 0.001). The median final height was within the normal range for males and females; 7 patients received growth hormone after transplantation. Conclusions: The outlook for successful transplantation is improving, and in the last decade was unaffected by age at transplantation. The survival of living-related donor transplants is superior to deceased-donor transplants for the first 5 years. From the above data, we can predict that a 10-year-old child receiving a renal transplant in 2000 and on ciclosporin-based immunosuppression can expect a transplant half-life of 13.1 years from a living-related donor and one of 10.8 years from a deceased-donor transplant.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Dr. Lesley Rees, MD
Department of Nephro-Urology
Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street
London WC1N 3JH (UK)
Tel. +44 207 813 8346, Fax +44 207 829 8841, E-Mail ReesL@gosh.nhs.uk

  Article Information

Received: May 9, 2006
Accepted: August 31, 2006
Published online: November 29, 2006
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 2, Number of References : 33