Improved Cadaveric Renal Transplant Outcome in Children

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 1991 Jan 1

PMID 2025523

Citations 19

Authors

R B Ettenger

J T Rosenthal

J L Marik

M Malekzadeh

S B Forsythe

E S Kamil

I B Salusky

R N Fine

Affiliations

Soon will be listed here.

Abstract

We analyzed the results of 165 pediatric cadaver renal transplants performed at the University of California at Los Angeles to identify the factors which are linked to improved allograft survival. Both univariate life-table analysis and the Cox proportional hazard model were used. The use of a sequential immunosuppressive regimen (P less than 0.001) and kidneys from donors of more than 6 years of age (P less than 0.001) were found to be the factors having the most influence on primary graft survival. The sequential regimen was the only factor favorably influencing retransplants. With sequential therapy 1- and 2-year actuarial graft survival rates were 94% and 91% in primary transplants, and 82% and 70% in retransplants. Medication noncompliance exerted a large negative effect on transplant outcome. Of 70 recipients who had been on cyclosporine for at least 6 months, 50% evidenced noncompliance. Sixty-four percent of adolescents were noncompliant. Thirteen percent of the recipients lost their graft because of noncompliance. We conclude that good results can be obtained with cadaver renal transplants in children with a sequential immunosuppressive regimen and the use of kidneys from adolescent and adult donors. Noncompliance is a great barrier to long-term success in pediatric transplantation.

Citing Articles

Adherence in pediatric kidney transplant recipients: solutions for the system.

Steinberg E, Moss M, Buchanan C, Goebel J Pediatr Nephrol. 2017; 33(3):361-372.

PMID: 28349215 DOI: 10.1007/s00467-017-3637-0.

Post-transplant adjustment--the later years.

Fredericks E, Zelikovsky N, Aujoulat I, Hames A, Wray J Pediatr Transplant. 2014; 18(7):675-88.

PMID: 25220845 PMC: 4179879. DOI: 10.1111/petr.12366.

Ellis E, Martz K, Talley L, Ilyas M, Pennington K, Blaszak R Pediatr Nephrol. 2008; 23(7):1149-55.

PMID: 18301925 DOI: 10.1007/s00467-008-0779-0.

Induction therapy in pediatric renal transplant recipients: an overview.

Moudgil A, Puliyanda D Paediatr Drugs. 2007; 9(5):323-41.

PMID: 17927304 DOI: 10.2165/00148581-200709050-00005.

Long-term outcome after renal transplantation in childhood.

Rees L Pediatr Nephrol. 2007; 24(3):475-84.

PMID: 17687572 PMC: 2755795. DOI: 10.1007/s00467-007-0559-2.

References

Snydman D, Werner B, Berardi V, Tilney N, Kirkman R, Milford E . Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N Engl J Med. 1987; 317(17):1049-54. DOI: 10.1056/NEJM198710223171703. View

Offner G, Hoyer P, BRODEHL J, Pichlmayr R . Cyclosporin A in paediatric kidney transplantation. Pediatr Nephrol. 1987; 1(2):125-30. DOI: 10.1007/BF00849281. View

Ettenger R, Rosenthal J, Marik J, Salusky I, Kamil E, Malekzadeh M . Successful cadaveric renal transplantation in infants and young children. Transplant Proc. 1989; 21(1 Pt 2):1707-8. View

Hoyer P, Offner G, BRODEHL J, Ringe B, Bunzendahl H, Pichlmayr R . Renal function and donor age: five years' experience with cyclosporin A. Transplant Proc. 1989; 21(1 Pt 2):1930-1. View

DRACHMAN R, Schlesinger M, Shapira H, Drukker A . The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy. Pediatr Nephrol. 1989; 3(3):305-8. DOI: 10.1007/BF00858537. View

. A randomized clinical trial of cyclosporine in cadaveric renal transplantation. N Engl J Med. 1983; 309(14):809-15. DOI: 10.1056/NEJM198310063091401. View

Hoyer P, Offner G, Wonigeit K, BRODEHL J, Pichlmayr R . Dosage of Cyclosporin A in children with renal transplants. Clin Nephrol. 1984; 22(2):68-71. View

Neiberger R, Weiss R, Gomez M, GREIFER I, Tellis V, Matas A . Elimination kinetics of cyclosporine following oral administration to children with renal transplants. Transplant Proc. 1987; 19(1 Pt 2):1525. View

Uittenbogaart C, Robinson B, Malekzadeh M, Pennisi A, Ettenger R, Fine R . Pretransplant T cell levels and renal allograft survival rates. Surgery. 1980; 87(4):432-5. View

10.

Beck D, Fennell R, Yost R, Robinson J, Geary D, Richards G . Evaluation of an educational program on compliance with medication regimens in pediatric patients with renal transplants. J Pediatr. 1980; 96(6):1094-7. DOI: 10.1016/s0022-3476(80)80653-6. View

11.

Ettenger R, Blifeld C, Prince H, Gradus D, Cho S, Sekiya N . The pediatric nephrologist's dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr. 1987; 111(6 Pt 2):1022-5. DOI: 10.1016/s0022-3476(87)80049-5. View

12.

Ellis D, Avner E, Rosenthal J, Taylor R, Young L, Palumbi M . Renal function and somatic growth in pediatric cadaveric renal transplantation with cyclosporine-prednisone immunosuppression. Am J Dis Child. 1985; 139(11):1161-7. DOI: 10.1001/archpedi.1985.02140130099040. View

13.

Rovelli M, Palmeri D, Vossler E, Bartus S, Hull D, Schweizer R . Noncompliance in organ transplant recipients. Transplant Proc. 1989; 21(1 Pt 1):833-4. View

14.

Balfour Jr H, Chace B, Stapleton J, Simmons R, Fryd D . A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Engl J Med. 1989; 320(21):1381-7. DOI: 10.1056/NEJM198905253202105. View

15.

Francis D, Millar R, Walker R, dApice A, CLUNIE G . Cadaver renal transplantation in children using low dose triple immunosuppression. Transplant Proc. 1989; 21(1 Pt 2):1696-7. View