PEDIATRICS

B. Sozeri¹, O.D. Kara¹, N. Dincel¹, A. Keskinoglu¹, C. Kabasakal¹, C. Hoscoskun², S. Mir^3
1Pediatric Nephrology, Ege university faculty of Medicine, Izmir/TURKEY, ²Surgery, Ege University Faculty of Medicine, Izmir/TURKEY, ³Pediatric Nephrology, Ege University Faculty of Medicine, Izmir/TURKEY

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INTRODUCTION: Renal transplantation remains the treatment of choice for end-stage renal failure in regard to patient survival. We report our experience with 96 renal transplantions (Rtx) performed in the Ege Univercity Medical Faculty Pediatric Renal Transplantation Unit between 1994-2008.Our aim was to evaluate the factors effecting graft survival in pediatric renal transplantation. METHODS: We retrospectively reviewed the pediatric renal transplant database at our institution. Recipient demographics, treatment indications, graft characteristics, treatment course, complications and graft outcomes were abstracted from clinical records. In addition to these data, number of HLA mismatches and ischemia time were also evaluated. Related variables collected through checklists were entered into SPSS software version 16. RESULTS: Ninety-six patients (50 girls/ 46 boys) were involved. Their mean RTx age was 12,2 ±4,1 years (range 1to 20 years). The causes of end-stage renal failure were FSGS (n=15, 15.6%), VUR (n=18.18.7%), Chronic pyelonephritis (n=9, 9,3%), Chronic glomerulonephritis (n=5, 5%), unknown (n=7, 7 %) and others (n=42). Transplantation from 38 (39,5%) living related donors (LRDs) and 58 (60,5%) cadaverics donors was performed. Preemptive RTx was performed in 3 patients and a second RTx was performed in one patient. The mean plasma creatinine levels of the recipients before renal transplantation were 6,7±2,6 mg/dl. In cadaveric kidney the mean cold ischemia time was 13,2±8,52 hours. The mean number of human leukocyte antigen (HLA) A/B/DR allele mismatches were 2,59±1,7 in the LRD graft recipients and 3,25 ±1,25 in the cadaver graft. Sixty-nine patients received induction therapy (36 had ATG, 33 had basiliximab).Triple immunosuppressive drugs comprising cyclosporine, prednisolone and mycophenolate mofetil were administered to patients. In 40 of them, the treatment was switched to another immunosupressant apart from prednisone. Surgical complications after transplantation were as follows: ureteric necrosis, ureteric obstruction, lymphocele. Hypertension (n=51, 59.3%), acute rejection (n=18, 20.9%), chronic allograft nephropahy (n=13, 15%) were the most common medical complications. All complications were more detected in cadaveric group. In patients who were treated for acute rejection had higher mismatches in HLA allele than other patients (2.88±1,23 vs 2.85±1.43, p=0.006). Ten (10.4%) patients died in follow up time. One-year graft survival was 100% in the LRD group while 98% in cadaver group. Ten year graft survival was %76 in the LDR and %72 in the cadaver group. Urinary tract Infection (UTI) (n=29, 29.2%) and Cytomegalovirus (CMV) (n=19,19.8%) infections were more detected in our recipients. The graft survey was better in LRD than cadaveric group. Also it was better in younger donor age and older recipient age among two groups. CONCLUSION: Although the survival rate of cadaveric grafts was in an acceptable range, quality of life was better in LRDs. We suggest that the best prognosis in graft survey will be obtaining by transplantation from young healthy donors to young non complicated recipients.

Disclosure: All authors have declared no conflicts of interest.