Kidney transplantation in young children: Should there be a minimum age?

A. Humar, L. Arrazola, M. Mauer, A. J. Matas, J. S. Najarian

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

The optimal age for transplantation in children with end-stage renal disease remains controversial. Many centers have adopted a policy of waiting until such children reach a certain minimum age or weight, maintaining them on chronic dialysis until then. Their policy is based on historical data showing inferior graft survival in very young children. We feel that with proper donor selection and recipient care, comparable results can be achieved in very young age groups. We herein present our results with kidney transplantation in children <1 year old. Between 1 January 1984 and 31 December 1999, we performed 321 kidney transplants in children ≤13 years at the University of Minnesota. We analyzed our results in three age groups: <1 year (n=30), 1 through 4 years (n=122), and 5 through 13 years (n=169). We found no significant differences in patient or graft survival rates between the three groups. Almost all our infant (<1 year) recipients underwent primary transplants from living donors (LDs). However, even when we compared results only of primary LD transplants between the three groups, we found no significant differences. To date, all our infant recipients are alive and well, 24 (80%) with a functioning original graft. Causes of the 6 graft losses were chronic rejection (n=3), vascular thrombosis (n=2), and recurrent disease (n=1). Infants had significantly lower incidences of acute and chronic rejection compared with older recipients, but a tendency to higher incidences of delayed graft function and vascular thrombosis. Infants had significant increases in weight post transplant: the mean standard deviation score rose from -2.8 pre transplant to -0.2 by age 5 years and to +1.8 by age 10 years. The improvement in height was less marked: the mean standard deviation rose from -3.2 pre transplant to -1.6 by age 5 years and to -1.4 by age 10 years. Kidney transplant results in very young children can be comparable to those in older children. There need be no minimum age for performing a kidney transplant. The timing of the transplant should not be based on age or size alone.

Original languageEnglish (US)
Pages (from-to)941-945
Number of pages5
JournalPediatric Nephrology
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2001

Fingerprint

Kidney Transplantation
Transplants
Living Donors
Graft Survival
Kidney
Blood Vessels
Thrombosis
Age Groups
Delayed Graft Function
Weights and Measures
Donor Selection
Incidence
Chronic Kidney Failure
Dialysis
Survival Rate
Transplantation

Keywords

  • Infants
  • Kidney transplants
  • Minimum age

Cite this

Kidney transplantation in young children : Should there be a minimum age? / Humar, A.; Arrazola, L.; Mauer, M.; Matas, A. J.; Najarian, J. S.

In: Pediatric Nephrology, Vol. 16, No. 12, 01.12.2001, p. 941-945.

Research output: Contribution to journalArticle

Humar, A. ; Arrazola, L. ; Mauer, M. ; Matas, A. J. ; Najarian, J. S. / Kidney transplantation in young children : Should there be a minimum age?. In: Pediatric Nephrology. 2001 ; Vol. 16, No. 12. pp. 941-945.
@article{75e017ff03da4cf8968cca74fe1dd22a,
title = "Kidney transplantation in young children: Should there be a minimum age?",
abstract = "The optimal age for transplantation in children with end-stage renal disease remains controversial. Many centers have adopted a policy of waiting until such children reach a certain minimum age or weight, maintaining them on chronic dialysis until then. Their policy is based on historical data showing inferior graft survival in very young children. We feel that with proper donor selection and recipient care, comparable results can be achieved in very young age groups. We herein present our results with kidney transplantation in children <1 year old. Between 1 January 1984 and 31 December 1999, we performed 321 kidney transplants in children ≤13 years at the University of Minnesota. We analyzed our results in three age groups: <1 year (n=30), 1 through 4 years (n=122), and 5 through 13 years (n=169). We found no significant differences in patient or graft survival rates between the three groups. Almost all our infant (<1 year) recipients underwent primary transplants from living donors (LDs). However, even when we compared results only of primary LD transplants between the three groups, we found no significant differences. To date, all our infant recipients are alive and well, 24 (80{\%}) with a functioning original graft. Causes of the 6 graft losses were chronic rejection (n=3), vascular thrombosis (n=2), and recurrent disease (n=1). Infants had significantly lower incidences of acute and chronic rejection compared with older recipients, but a tendency to higher incidences of delayed graft function and vascular thrombosis. Infants had significant increases in weight post transplant: the mean standard deviation score rose from -2.8 pre transplant to -0.2 by age 5 years and to +1.8 by age 10 years. The improvement in height was less marked: the mean standard deviation rose from -3.2 pre transplant to -1.6 by age 5 years and to -1.4 by age 10 years. Kidney transplant results in very young children can be comparable to those in older children. There need be no minimum age for performing a kidney transplant. The timing of the transplant should not be based on age or size alone.",
keywords = "Infants, Kidney transplants, Minimum age",
author = "A. Humar and L. Arrazola and M. Mauer and Matas, {A. J.} and Najarian, {J. S.}",
year = "2001",
month = "12",
day = "1",
doi = "10.1007/s004670100000",
language = "English (US)",
volume = "16",
pages = "941--945",
journal = "Pediatric nephrology (Berlin, Germany)",
issn = "0931-041X",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Kidney transplantation in young children

T2 - Should there be a minimum age?

AU - Humar, A.

AU - Arrazola, L.

AU - Mauer, M.

AU - Matas, A. J.

AU - Najarian, J. S.

PY - 2001/12/1

Y1 - 2001/12/1

N2 - The optimal age for transplantation in children with end-stage renal disease remains controversial. Many centers have adopted a policy of waiting until such children reach a certain minimum age or weight, maintaining them on chronic dialysis until then. Their policy is based on historical data showing inferior graft survival in very young children. We feel that with proper donor selection and recipient care, comparable results can be achieved in very young age groups. We herein present our results with kidney transplantation in children <1 year old. Between 1 January 1984 and 31 December 1999, we performed 321 kidney transplants in children ≤13 years at the University of Minnesota. We analyzed our results in three age groups: <1 year (n=30), 1 through 4 years (n=122), and 5 through 13 years (n=169). We found no significant differences in patient or graft survival rates between the three groups. Almost all our infant (<1 year) recipients underwent primary transplants from living donors (LDs). However, even when we compared results only of primary LD transplants between the three groups, we found no significant differences. To date, all our infant recipients are alive and well, 24 (80%) with a functioning original graft. Causes of the 6 graft losses were chronic rejection (n=3), vascular thrombosis (n=2), and recurrent disease (n=1). Infants had significantly lower incidences of acute and chronic rejection compared with older recipients, but a tendency to higher incidences of delayed graft function and vascular thrombosis. Infants had significant increases in weight post transplant: the mean standard deviation score rose from -2.8 pre transplant to -0.2 by age 5 years and to +1.8 by age 10 years. The improvement in height was less marked: the mean standard deviation rose from -3.2 pre transplant to -1.6 by age 5 years and to -1.4 by age 10 years. Kidney transplant results in very young children can be comparable to those in older children. There need be no minimum age for performing a kidney transplant. The timing of the transplant should not be based on age or size alone.

AB - The optimal age for transplantation in children with end-stage renal disease remains controversial. Many centers have adopted a policy of waiting until such children reach a certain minimum age or weight, maintaining them on chronic dialysis until then. Their policy is based on historical data showing inferior graft survival in very young children. We feel that with proper donor selection and recipient care, comparable results can be achieved in very young age groups. We herein present our results with kidney transplantation in children <1 year old. Between 1 January 1984 and 31 December 1999, we performed 321 kidney transplants in children ≤13 years at the University of Minnesota. We analyzed our results in three age groups: <1 year (n=30), 1 through 4 years (n=122), and 5 through 13 years (n=169). We found no significant differences in patient or graft survival rates between the three groups. Almost all our infant (<1 year) recipients underwent primary transplants from living donors (LDs). However, even when we compared results only of primary LD transplants between the three groups, we found no significant differences. To date, all our infant recipients are alive and well, 24 (80%) with a functioning original graft. Causes of the 6 graft losses were chronic rejection (n=3), vascular thrombosis (n=2), and recurrent disease (n=1). Infants had significantly lower incidences of acute and chronic rejection compared with older recipients, but a tendency to higher incidences of delayed graft function and vascular thrombosis. Infants had significant increases in weight post transplant: the mean standard deviation score rose from -2.8 pre transplant to -0.2 by age 5 years and to +1.8 by age 10 years. The improvement in height was less marked: the mean standard deviation rose from -3.2 pre transplant to -1.6 by age 5 years and to -1.4 by age 10 years. Kidney transplant results in very young children can be comparable to those in older children. There need be no minimum age for performing a kidney transplant. The timing of the transplant should not be based on age or size alone.

KW - Infants

KW - Kidney transplants

KW - Minimum age

UR - http://www.scopus.com/inward/record.url?scp=0035668118&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035668118&partnerID=8YFLogxK

U2 - 10.1007/s004670100000

DO - 10.1007/s004670100000

M3 - Article

C2 - 11793077

AN - SCOPUS:0035668118

VL - 16

SP - 941

EP - 945

JO - Pediatric nephrology (Berlin, Germany)

JF - Pediatric nephrology (Berlin, Germany)

SN - 0931-041X

IS - 12

ER -