PEDIATRICS

C. Wang¹, L. Liu², J. Li¹, L. Chen³, S. Deng¹, J. Fei², J. Qiu³, Q. Fu^1
1Organ Transplant Center, The First Affiliated Hosptial, Sun Yat-sen University, Guangzhou/CHINA, ²Organ Transplantation Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou/CHINA, ³Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou/CHINA

Body: Introduction Compared with uremic adults, pediatric patients have less opportunity to receive kidney transplantation (KTx) in China. In recent years, living-related KTx has developed much in China, and the number of pediatric KTx has been increased. The first living-related KTx in China was performed in 1972 in our center. Moreover, we have the most number of pediatric KTx in China. Herein, we reported the living-related pediatric KTx in our center. Methods Eight living-related pediatric KTx were performed from July 2007 to November 2008. The donors were female and at the age of 24 to 45 years old. The age of recipients was 12.1 ± 5.4 (4-17) years. The body weight was 10.5-55 kg. Three transplant incisions were intraperitoneal, and five incisions were extraperitoneal approaches. Renal graft artery was anastomosed to abdominal aorta in three children, and to right common iliac artery in one child. Renal graft vein was anastomosed to inferior vena cava in these four children. Renal graft artery and vein were respectively anastomosed to right external iliac artery and vein in the other four patients. Seven patients were induced with antithymocyte globulin, daclizumab or basiliximab. One patient was prescribed daily cyclosporine A (CsA, 50 mg bid) and mycophenolate mofetil (MMF, 0.25g bid) three days before surgery. The maintenance immunosuppressive regimens were CsA (n=4) or tacrolimus (FK506, n=4) combined with MMF and prednisone (Pred). Results Serum creatinine (sCr) in all the donors increased after nephrectomy, and decreased to normal line in 3~7 postoperative days in six donors, while sCr on day 7 was higher than preoperative level (86.5 ± 21.2 vs 58.6 ± 9.2 μmol/L, p<0.05). Serum creatinine in one donor decreased to 110 μmol/L six months after surgery. Serum creatinine decreased to normal line within three days after transplant in six recipients, two of whom developed acute rejection (AR) due to insufficient dose of tacrolimus. AR was reversed by anti-rejection therapy. In the other two patients, sCr decreased to normal level two months after transplantation, or fluctuated from 150 μmol/L to 180 μmol/L. CsA was converted to FK506 in one female patient due to CsA-induced hirsutism, and in two male patients due to slow graft function (SGF). Recipients have been followed-up from 15 to 32 months, and all recipients and grafts survived. Serum creatinine maintained at 154μmol/L in one SGF patient, decreased to 96.4 μmol/L in an AR patient, and maintained at 71.5 ± 30.5 μmol/L in the other six patients. Conclusion Compared to adult patients, uremia children have unsatisfactory preoperative body condition, smaller blood vessels, and higher risk of acute rejection. Sufficient immunosuppression is important for graft survival.

Disclosure: All authors have declared no conflicts of interest.