The use of cadaver kidneys for transplantation in young children

The Role Of Cadaver Kidney Transplantation In The Management Of End-Stage Renal Disease In Young Children Is Controversial. To Assess The Current Risk-Benefit Ratio Of Cadaver First And Second Kidney Transplants In Recipients Under 6 Years Of Age, We Compared The Outcome Of 19 Transplants Performed Between 1984 And 1989 Using A Quadruple-Drug Regimen (Minnesota Antilymphocyte Globulin, Azathioprine, Prednisone, Cyclosporine) With The Outcome Of 25 Transplants Performed Prior To 1984 Without The Use Of Cyclosporine At A Single Institution. Twenty-Five Transplants Were In Children Under The Age Of 3 Years. In The Last Decade Patient Survival Has Significantly Improved. One-Year Patient Survival Improved From 53% Before 1979 To 90% Since 1979 (P<0.05). The Use Of The Quadruple-Drug Regimen Since 1984 Was Associated With A Significant Improvement In One-Year Cadaver Graft Function From 40% Before 1979 To 78% In Recipients Under 6 Years Of Age, And From 22% To 82% In Recipients Under 3 Years Of Age (P<0.05). With The Quadruple-Drug Regimen, One-Year And Four-Year Graft Function Rates For Children Under 6 Years Of Age Were 83% For First Cadaver Transplants And 72% For Second Cadaver Transplants, Which Were Essentially The Same Results As In Older Children And Adults. Children Who Received Kidneys From Donors Over 4 Years Of Age Achieved The Best Result, With 87% One-Year Graft Function Compared With 50% For Kidneys From Donors Under 4 Years Old. In 15 Children With Successful Transplants, 8 (53%) Showed Accelerated Growth, 5 (33%) Had Normal-Velocity Growth, And Only 2 Children (14%) With Suboptimal Renal Function Had Poor Growth Following Transplantation. Therefore, We Believe That With A Quadruple-Drug Immunosuppressive Protocol, Cadaver Renal Transplantation Using Kidneys From Adults Or Pediatric Donors Over 4 Years Old Is An Acceptable Form Of Treatment In Young Children With End-Stage Renal Disease For Whom There Are No Suitable Living-Related Donors.