A new immunosuppressive regimen combining anti-lymphocyte globulin, azathioprine,prednisone, and low doses of cyclosporine was used in 28 children aged 9 months to 17 years (mean 5.8 years) who recelved primary renal allografts between July 1, 1984, and September 25, 1986. After a mean follow-up of 17.3 months, the patient and graft survival is 100% (18 of 18) for mismatched related kidneys, and 90% (nine of 10) for cadaver kidneys. The single graft failure was the result of a death from technical complications. Serum creatinine concentration after transplantation ranged from 0.3 to 1.7 mg/dL (mean 0.85 mg/dL). The probability of a rejection episode in the first year was 45% and 60% for mismatched-related and cadaver kidneys, respectively. Cyclosporine nephrotoxicity was recognized in only one (3.7%) of 27 children, and was rapidly reversed after cyclosporine was discontinued. An initial group of nine children was weaned from cyclosporine therapy 6 to 12 months after transplantation, but two (22%) had rejection episodes. Our preliminary experience suggests that the use of a guadruple immunosuppressive regimen for both living related and cadaver renal transplants in children is associated with an improved graft function rate and a low incidence of complications.
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We have recently reported that long-term graft function and patient survival rates after primary renal transplantation in children are very good and in our experience are not significantly different from the outcome in young nondiabetic adult recipients. 1,2 Using standard immunosuppression consisting of anti-lymphocyte globulin, azathioprine, and prednisone, pretransplant splenectomy, and random transfusions, the 1-year graft function was 100%, 92%, and Supported in part by grants AM 13083, AM 2518, and HD 17386, National Institutes of Health. Reprint Requests: Dr. Samuel So, Department of Surgery, University of Minnesota Hospital, Box 263 UMHC, Minneapolis, MN 55455.