UroToday - Tangeraas, et al. retrospectively reviewed their experience with pediatric renal transplantation between the years of 1970 to 2006. Overall, 251 renal transplantations were performed in 178 children in Norway. 84% of the transplantations were living donors and 52% were performed preemptively. Pre transplant dialysis was a median of three months. Factors leading to renal failure were structural abnormalities and heredity renal disease, while 29% were caused by glomerulopathies, while the remaining 2% were of unknown causes. Patient survival rates were 94.2, 93.5 and 84.4% at 5, 10 and 20 year intervals, respectively. The most frequent cause of death in this population was infections followed by cardiovascular events.

149 patients were recipients of living donor grafts. In this group, survival of the first transplantation was 82% at 5 years, 68.8% at 10 years and 45.1% at 20 years. The overall graft survival was higher in the living donor patients than the cadaveric donor organs. This observation of better graft survival with the living donors as compared to the cadaveric donors became the only significant predictor for better transplant survival in this study. Interestingly the acute rejection rate declined significantly from 61.5% in the 1970s to 14.5% between 2000 and 2006. This of course correlates with the improved immunosuppressive therapy. However, it still remains unclear whether immunosuppressive therapy will have a positive impact on long term graft survival in the future.

Tangeraas T, Bjerre A, Lien B, Kyte A, Monn E, Cvancarova M, Leivestad T, Reisæter AV

Pediatr Transplant. 2008 Jan 14 (Epub ahead of print)
doi: 10.1111/j.1399-3046.2007.00896.x

Reported by UroToday Medical Editor Pasquale Casale, MD

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