Abstract

CANO SCH., Francisco et al. Pediatric renal transplant. Rev. bol. ped. [online]. 2003, vol.42, n.1, pp.69-76. ISSN 1024-0675.

Paedriatric renal transplantis the treatment of choice in chronic renal failure(CRF), in that it permits the recuperation to differing degrees the severe consequences of uraemia, especially in terms of growth retardation. Objective: To evaluate the results of renal transplantation in 3 hospital centers during a 10 year period(1989-99). Patients and Methods: A retrospective study using a standard protocol carried out in the hospitals Exequiel Gonzá1ez Cortés,Luis Calvo Mackenna and San Juan de Dios between july 1989 and july 1999. 3 types of variables were analyzed; 1)demograpbic description, 2)growth between birth and the last year of follow-up, and 3) transplant related factors, especially innnunosuppression, transplantcomplications and graft function during annual periods.Continuous variables were expressed as mean + SD, growth as Z score, renal function as l/plasma creatinine, and togelher with the analysis of acute rejection in relation to live or cadaveric donor, were analyzed using Pearsons Chi-squared. Renal function with regards to warm or cold ischaemia was evaluated using Students t-test ,while Kaplan-Meier curves were used in the analysis of survival at 1,3, and 5 years both for patients and grafts. In all the tests a pvalue< 0,05 was considered significant. Results: 98 transplants were carried out on92patients, aged 10.9 + 3.2 years, range 2-17,the 3 most important causes of CRF were reflux nephropathy, renal dis-or hypoplasia and chronic glomerulonephritis. Growth showed a fall from a Z of-0.6 at birth, to-2.14 at the beginning of dialysis (p <0.05) to-2.57 at the moment of transplant (p < 0,05). At 3 and 5 yrs post transplant the Z values were-2.38 and-2.93 respectively. Actuarial patient survival rates at 1,3 and 5 yrs were 97.8, 95.2 and 92.6 for live donors and 92.6,92.6,and 92.6 for cadaveric donors respectively. Graft survival for livedonors was 89,78 and 71% and cadaveric donors 84, 76 and 70% during the same time intervals. Reasons for graft failure were abandoning treatment 8 cases, renal vessel thrombosis 6, chronic rejection 4 and acute rejection 3 cases,4 patients died, 2 from septicaemia, 1 from bronchopneumonia and 1dueto renal artery rupture. Conclusions: This report confirms that paedriatric renal transplant can be performed in Chile with an acceptable morbidity, a low mortality and with graft survivals similar to intemational centers.

Keywords : Renal transplantation; inmunosupresion; growth; graft; survival complications.