Transplantation of kidneys from children

During an 11-year period from 1978 to 1988, 720 cadaver kidneys were transplanted at the University Hospital of Zurich. 103 of the kidney grafts were from donors 16 years old or younger. The mean age of these donors was 11 years (range 2 1/3 to 16 years). There were 3 donors under 5 years, where we preserved and transplanted both kidneys en bloc. Only 3 recipients were less than 16 years old. After 1 year, 67 out of 103 recipients had a functioning pediatric graft. In the cyclosporine-treated group, the 1-year graft survival was even 80%, similar to kidney transplants from adult donors. Graft loss was observed in 48 cases. 33 patients rejected the transplant and 10 grafts were lost after recurrence of the primary renal disease. Only 5 grafts had a vascular complication. We conclude that kidneys from pediatric donors can successfully be transplanted into adults.     

Pediatric cadaver kidney transplants into adults

During a 5-year period 77 adults received single kidney cadaver transplants from donors 16 months to 16 years old. Cyclosporin immunosuppression was not used. Three recipients had ischemic ureteral complications, 1 of which resulted in allograft loss. Of the kidney grafts 34 were from donors 8 years old or younger, and comparison of renal function was made with the 43 adult recipients of cadaver kidneys from older children. The mean 1-month serum creatinine nadir was significantly higher in the recipients of kidneys from the younger children (2.6 plus or minus 1.6 versus 1.9 plus or minus 0.8 mg./per dl.). There were no statistically significant differences in 1-week dialysis requirement, 1-month kidney graft function or actuarial kidney graft survivals and serum creatinine levels at 3, 6, 12 and 24 months after grafting. Cadaver kidneys from young donors can be transplanted successfully into adults.     

Deceased Donor Kidney Transplantation from Donors with Acute Renal Failure due to Rhabdomyolysis

With the current shortage of solid organs for transplant, the transplant community continues to look for ways to increase the number of organ donors, including extending the criteria for donation. In rhabdomyolysis, the byproducts of skeletal muscle breakdown leak into the circulation resulting in acute renal failure in up to 30% of patients. In nonbrain dead patients, this condition is reversible and most patients recover full renal function. Seven potential donors had rhabdomyolysis with acute renal failure as evidenced by the presence of urine hemoglobin, plasma creatinine kinase levels of greater than five times the normal and elevated creatinine. One donor required dialysis. At our institution, 10 kidneys were transplanted from the seven donors. Two grafts had immediate function, five grafts experienced slow graft function and three grafts had delayed graft function requiring hemodialysis. At a mean of 8.7 months posttransplant (2.4–25.2 months), all patients have good graft function, are off dialysis and have a mean creatinine of 1.3 (0.7–1.8). In conclusion, our experience suggests that rhabdomyolysis with acute renal failure should not be a contraindication for donation, although recipients may experience slow or delayed graft function.     

Effect of increased arterial resistance index on long‐term outcome of well‐functioning kidney grafts

Abstract An abnormal vascular status is present in the transplanted kidney. To define whether vascular factors might influence kidney function of the graft, the renal volume, blood flow and vascular resistance of a group of healthy subjects were compared with those of a group of well functioning renal transplants by color Doppler ultrasonography. Sixty healthy subjects and 75 well functioning cadaver renal transplant recipients were compared by color Doppler ultrasonography. Subsequently, 15 couples of donors and recipients of a living related renal graft were compared to observe the differences between the two organs of the same subject in a different environment. The variables studied were: the diameters and the volume of the kindey, renal blood flow and renal resistance index (RI). The group of cadaver renal transplant patients showed higher mean blood pressure (P = 0.009), higher serum creatinine levels (P = 0.0001) and lower endogenous creatinine clearance (P < 0.0001) than healthy controls. The length (P < 0.00001) and volume (P < 0.001) of the kidneys of cadaver transplanted patients were significantly greater than those of healthy subjects, while the length and volume of the living donors kidneys were identical to those of the recipients. RI, measured on renal vessels, showed lower values in healthy subjects and in kidney donors than in transplantated patients (P < 0.00001). Well functioning transplanted kidneys showed increased renal arterial RI. This non‐immunologic factor did not appear to be detrimental with renal function in time, at least until 50 months after successful grafting.     

Transplantation of pediatric donor kidneys to adult recipients. Is there a critical donor age?

Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were compared. Recipient age for all groups was similar (34-36 years). Life table analysis revealed no difference in graft survival in recipients of kidneys from donors aged 2, 3, 4, 5-10, and 11-15 when compared with adult donors. Graft survival in these groups improved over time with current 1-year survival over 75%. Recipients from donors less than 24 months of age demonstrated significantly poorer results, with no kidney surviving greater than 2 months. Serum creatinine of grafts functioning greater than 6 months was similar in all groups. It is concluded that single pediatric kidneys from donors greater than 2 years of age can be successfully transplanted to adults with good long-term results.     

Long-term outcomes of single paediatric vs. ideal adult renal allograft transplants in adult recipients

AIM: To compare the outcomes of single paediatric vs. adult kidneys transplanted into adult recipients. METHODS: A retrospective single-centre review of 38 single cadaver kidney transplants from donors less than five yr of age to wait-listed patients of low body mass index (BMI). Survival of grafts and quality of renal function were compared with 121 similarly low BMI recipients of grafts from donors 18-45 yr of age that were transplanted during the same period. Immunosuppression consisted of sirolimus, minimal-dose cyclosporine and prednisone. The mean age of the paediatric vs. adult donors was 2.8+/-1.0 and 31.1+/-9.2 yr, respectively (p<0.01) and of the recipients, 42.0+/-12.4 and 45.7+/-14.8 yr, respectively (p=NS). The mean BMI of paediatric vs. adult donor kidney recipients was 21.8+/-2.9 and 22.4+/-2.0 kg/m2 (p=NS). Sixty-six per cent of paediatric donor recipients were women compared with 44% of adult donor recipients (p=0.03). RESULTS: Death censored actuarial graft survivals at one and five yr for recipients of paediatric vs. adult donor grafts were 93 and 84% compared with 93 and 85% (p=NS). There were no graft losses because of technical complications in the paediatric kidney donor group. At one and five yr post-transplantation, the mean estimated creatinine clearances of the paediatric donor graft recipients were 52.9+/-19.6 and 54.0+/-17.8 mL/min, respectively, compared with 56.4+/-19.8 and 49.1+/-21.7 mL/min for recipients of adult donor grafts at the same times (p=NS). CONCLUSION: Transplantation of single paediatric donor kidneys into low BMI adult recipients provided equivalent outcomes to those of grafts from adult donors between the ages of 18 and 45 yr.     

Hypertension in standard criteria deceased donors is associated with inferior outcomes following kidney transplantation

Singh RP, Farney AC, Rogers J, Gautreaux M, Reeves‐Daniel A, Hartmann E, Doares W, Iskandar S, Adams P, Stratta RJ. Hypertension in standard criteria deceased donors is associated with inferior outcomes following kidney transplantation.
Clin Transplant 2011: 25: E437–E446. © 2011 John Wiley & Sons A/S. Abstract: Background: Hypertension may be a either a cause or an effect of kidney disease. Although hypertension is an important component of the expanded criteria donor definition, risks of transplanting deceased donor kidneys from hypertensive standard criteria donors (SCD) are less well understood. Methods: Retrospective single‐center study in all adult patients who received a deceased donor kidney transplant from a SCD to evaluate the role of donor hypertension as a pre‐transplant risk factor for death‐censored graft loss (DCGL) and renal function. Results: From October 2001 through May 2008, 297 kidney transplants were performed from donation after brain death SCDs. A total of 47 (15.8%) grafts were lost, including 19 (6.4%) deaths with functioning grafts. Univariate analysis of death‐censored cases (n = 278) identified history of donor hypertension, cold ischemia time (CIT) >30 h, and African American (AA) recipients as significant pre‐transplant risk factors predictive for DCGL at five yr follow‐up (mean 38 months, all p < 0.02). Cox regression analysis showed donor hypertension (relative risk 2.2, p = 0.04) to be a significant risk factor for DCGL, whereas CIT >30 h and AA recipient ethnicity showed only trends toward DCGL. Renal function as determined by serum creatinine levels was significantly higher in recipients of hypertensive compared with non‐hypertensive SCD kidneys at all time points out to 48 months follow‐up and the disparity in renal function increased over time. Conclusions: Transplanting SCD kidneys from hypertensive donors is associated with worse graft function and an increased risk of graft loss.     

Ten years of training community urologists and general surgeons to do cadaver kidney retrievals

We trained 82 community hospital cadaver kidney retrieval teams during a 10-year period ending June 30, 1987. During the last 5 years of that period the concept of multiple organ retrieval was introduced into the training sessions and 429 cadaver kidney grafts were retrieved. Of those kidneys 292 were transplanted at our hospital, and the function of 220 cadaver kidney grafts retrieved by the community hospital teams was compared to that of 72 retrieved by the transplant center retrieval team. Of the cadaver kidney transplants 114 were from multiple organ donors. There was no significant difference in 1-month serum creatinine nadir of surviving grafts (2.1 +/- 1.8 versus 1.9 +/- 1.7 mg. per dl.), 6-month serum creatinine level (1.7 +/- 0.8 versus 1.6 +/- 0.6 mg. per dl.), 12-month serum creatinine level (1.8 +/- 0.9 versus 1.6 +/- 0.6 mg. per dl.) and 5-year actuarial graft survival (44.8 +/- 4.1 versus 52.4 +/- 7.5%), with the community hospital data presented first. The delayed graft function rate was significantly higher in the recipients of cadaver kidney grafts retrieved by community hospital teams (54 versus 35%), which was reduced by the in situ flush technique. There was no significant difference in delayed graft function rate (48 versus 40%) for the 114 cadaver kidney transplants retrieved from multiple organ donors by either community hospital or transplant center teams. With continuing education and quality control, community hospital retrieval teams can provide kidneys satisfactory for transplantation, even when working with multiple organ retrieval teams.     

Outcome of renal transplants from pediatric donors <5 yr of age

AIM: Outcomes of single renal transplants from donors <5 yr old have traditionally been inferior to those from older donors. We retrospectively studied our experience with patients who received renal transplants, either individually or en bloc, from young donors (<5 yr of age) to determine the utility of these organs. We also compared the outcomes of these transplant patients maintained on either cyclosporine- (CyA) or tacrolimus-based (TRL) immunosuppression regimens. PATIENTS: Ninety-eight patients received transplants at our center from donors <5 yr of age between August 1993 and August 2003. They were followed-up from 12 months to 11 yr. Patients were divided into four groups based on whether they received single or en bloc transplants, and whether CyA or TRL was the base immunosuppressive agent. Patients in group I (n = 13) received single pediatric kidneys and were treated with CyA regimens; group II patients (n = 26) also received single pediatric kidneys, but were treated with TRL regimens; group III patients (n = 31) were transplanted en bloc and were treated with CyA; and group IV patients (n = 28) received en bloc transplants and were treated with TRL. RESULTS: One-year patient and death-censored graft survival was not significantly different between recipients of en bloc vs. single grafts (i.e. 88 and 85% vs. 90 and 87%, respectively), or between the four treatment groups (group I: 85 and 85%, group II: 92 and 88%, group III: 87 and 84%, and group IV: 89 and 86%, respectively). The overall 1-yr rejection rate was 30% (29 of 98), which was significantly higher in the CyA-treated patients 19 of 44; i.e. 43%, than in TRL-treated patients 10 of 54, i.e. 19%, p = 0.03). In the en bloc recipients, seven grafts (12%) were lost as a result of vascular thrombosis. Notably, none of the single kidneys were lost because of vascular thrombosis. At the end of follow-up the creatinine levels of both groups were comparable. CONCLUSIONS: Pediatric donor kidneys transplanted individually provide for equal patient and graft survival when compared with en bloc transplants. TRL can be used reduce the detrimental effect of acute rejection on graft growth and function when compared with CyA. Single use of such kidneys can safely and efficaciously be transplanted into adult recipients, greatly expanding the donor pool.     

Effect of transfusion of donor on allograft survival

It has been reported by two European transplant centers that blood transfusion of cadaver donors with third-party blood prior to nephrectomy increases renal allograft survival rates by approximately 30% at 1 year. A retrospective analysis in our center was performed on 293 kidney recipients, 110 of whom received kidneys from untransfused donors. Actuarial analyses revealed no significant differences in graft survival rates between all nontransfused donor kidneys and all transfused donor kidneys. Considering only first transplant recipients, there was no difference in graft survival rates between nontransfused donor kidneys and transfused donor kidneys. In addition, when only preoperatively transfused recipients receiving first transplants were examined, there was no difference in graft survival rates between nontransfused donor kidneys and transfused donor kidneys. Animal studies were performed with (Lewis x Brown Norway)F1 (LBNF1) hybrid rat hearts transplanted heterotopically to the abdomens of Lewis rat recipients. Six LBNF1 heart grafts had a mean survival time of 8.0 +/- 1.1 days. Five LBNF1 rats received 2 ml of heparinized whole blood from Charles River (CD) rats 24 hr before heart transplantation to Lewis recipients. The transfused LBNF1 grafts had a mean survival time of 6.6 +/- 0.9 days. Therefore, donor blood transfusion does not appear to prolong graft survival in this retrospective human study or in the animal model.     

Results of renal transplantation using pediatric cadaver donors.

In order to determine the results of transplantation using pediatric cadaver donors, a retrospective analysis of a series of 502 renal transplant recipients was carried out. Methods of procurement, preservation, recipient selection, and immunosuppressive regimen were similar for all patients. Sixty-five recipients were approximately equally divided into three groups whose donors were younger than 5 years of age, 6 to 10 years old, and 11 to 15 years. These three groups then were compared with each other and to a randomly selected representative group of recipients whose donors were adults (16 years or older) for the following parameters: actuarial graft and patient survival, causes of graft failure and patient death, level of serum creatinine in currently functioning grafts, and recipient age. There were no statistically significant differences between groups for any parameter except that the mean age of recipients was approximately 16 years for the donors up to 5 years of age and was between 31 and 36 years for the other donor age groups (P = 0.01). These results support the contention that brain-dead pediatric patients of any age should be considered to be potential cadaveric kidney donors. Exclusion of these patients is very wasteful and also is unnecessary since results of transplantation equal to those obtained with adult donors can be expected. Technical graft failures should not be more frequent than with adult kidneys, and there is no need to modify the basic surgical technique for small kidneys in order to achieve this.     

Outcome of transplantation using kidneys from controlled (Maastricht category 3) non-heart-beating donors

BACKGROUND: Many renal transplant centres are reluctant to use kidneys from non-heart-beating (NHB) donors because of the high incidence of primary non-function and delayed graft function reported in the literature. Here, we report our favourable experience of using kidneys from Maastricht category 3 donors (controlled NHB donors). MATERIALS AND METHODS: From January 1996 to June 2002, 42 renal transplants using kidneys from 25 controlled NHB donors were undertaken at our centre. The rates of primary non-function, delayed graft function (DGF), rejection and long-term graft and patient survival were compared with those of 84 recipients of grafts from heart-beating (HB donors) transplanted contemporaneously. RESULTS: Primary non-function did not occur in recipients of grafts from NHB donors but was seen in two grafts from HB donors. DGF occurred in 21 of 42 (50%) kidneys from NHB donors and 14 of 84 (17%) kidneys from HBD donars (p < 0.001). The acute rejection rates in the two groups were similar (33% for grafts from NHB donors vs. 40% from HB donors). By 1 month after transplantation, there was no significant difference in serum creatinine concentration between the two groups. Over a median follow-up period of 32 months (range 2-75 months), the actuarial graft survival rates at 1, 3 and 5 yr after transplantation were 84, 80 and 74% for recipients of kidneys from NHB donors, compared with 89, 85 and 80% for kidneys from HB donors. CONCLUSION: Controlled NHB donors are a valuable and under-used source of kidneys for renal transplantation. The outcome for recipients of kidney allografts from category 3 NHB donors is similar to that seen in recipients of grafts from conventional HB cadaveric donors.     

Transplantation of pediatric cadaveric kidneys into adult or pediatric recipients

In Japan, nationwide cadaveric organ sharing for kidney transplantation by the Japan Organ Transplant Network (JOTN) has operated since April 1995. This study retrospectively analyzed the long-term results of single pediatric donor kidneys transplanted into adult or pediatric recipients at a single center. From March 1983 to December 2002, 281 cadaveric renal allografts were transplanted at our center, including, 17 recipients of cadaveric kidneys from donors aged less than 16 years. We divided these 17 recipients into two groups: 10 adult recipients (group 1; G1) and seven pediatric recipients (group 2; G2). HLA-AB, -DR mismatches were 1.3 +/- 1.3, 0.7 +/- 0.5 in G1 and 2.6 +/- 1.3, 1.4 +/- 0.8 in G2, respectively (P < .05 for both). The end of the observation of this study was March 2003. Among G1, two recipients died with functioning grafts and one died after graft loss. Among G2, no recipients died. Patient survival rates at 1 and 5 years were 90% and 80% in G1 and 100% and 100% in G2, respectively. At the end of the observation in this study, five recipients among G1 and six recipients among G2 had functioning grafts. Graft survival rates at 1 and 5 years were 90% and 80% in G1 and 85.7% and 85.7% in G2, respectively. Our results demonstrate that transplantation of pediatric cadaveric kidneys into pediatric recipients was excellent compared to adult recipients in terms of survival. Priority to pediatric patients should be given especially in cases of pediatric donors.     

Transplantation of single pediatric kidneys into adult recipients

AIM: To evaluate the outcome of single pediatric kidneys transplanted into adult recipients. METHODS: A retrospective single-center review was performed of transplants from donors less than 5 years of age. Outcomes were compared with recipients of grafts from donors 18 to 45 years transplanted during the same time period. RESULTS: Thirty single renal transplants from pediatric donors and 117 transplants from adult donors between 18 and 45 years of age were performed during the study period. The mean age of the pediatric donors was 2.9 +/- 0.8 years versus 31.5 +/- 8.9 years for adult donors (P < .001). The mean age of the recipients of pediatric donors was 41.9 +/- 13 years versus 48 +/- 12.6 years for recipients of adult grafts (P = .020). The mean recipient weight of pediatric donors was 55.9 +/- 7.8 kg versus 78.0 +/- 17.7 kg for recipients of adult donors (P < .001). Sixty-six percent of pediatric donor recipients were of female gender compared to only 36% of adult donor recipients (P = .005). Death-censored actuarial graft survivals at 1 and 4 years for recipients of pediatric donor grafts were 90% and 85% compared to 93% and 85% for recipients of adult donor grafts (P = NS). The mean calculated creatinine clearances of adult donor graft recipients at 1 and 4 years posttransplantation were 70.8 +/- 26.5 and 73.7 +/- 27.2 mL/min, respectively, compared to 50.3 +/- 20.1 and 56.3 +/- 21.4 mL/min for pediatric donor grafts (P < .01 at 1 and 4 years). CONCLUSION: The use of single pediatric donor kidneys provides an excellent opportunity to safely expand the donor pool.     

Outcome of renal allografts from non-heart-beating donors with delayed graft function

Delayed graft function (DGF) in renal transplantation using non-heart-beating donors (NHBDs) usually exceeds 80%. There is debate whether DGF in this subgroup is associated with poor long-term outcome. Between 1 January 1988 and 31 January 2000, 130 of 158 (82.3%) NHBD graft recipients with functioning grafts transplanted within our regional NHBD programme developed DGF. Overall graft survival and graft survival censored for recipient death was 113/130 (86.9%) versus 113/121 (93.4%) at year 1, 55/84 (65.5%) versus 55/64 (85.9%) at year 5 and 18/40 (45.0%) versus 18/28 (64.3%) at year 10 after transplantation. Seventeen grafts (13.1%) were lost due to rejection or graft nephropathy. Nine of these kidneys failed during the 1st year. Twenty-seven patients (20.8%) died with functioning grafts, eight within the 1st year after transplantation. In those patients who survived, DGF was associated with excellent long-term outcome in this study. The number of grafts lost due to recipient death exceeded those lost due to rejection or graft nephropathy.     

Ways to Boost Kidney Transplant Viability: A Real Need for the Best Use of Older Donors

Using kidneys from expanded criteria donors (ECD) increased transplant activity but resulted in a reduced graft survival. The relatively poor long-term outcome of ECD grafts may be the consequence of an imbalance between the number of viable nephrons supplied and the metabolic demand of the recipient. Providing more nephrons by dual transplants may improve outcomes but fails, per se, to confer the same benefit of single transplants from young donors. A biopsy-based score system has been presented by a panel of pathologists to assess whether kidneys from donors older than 60 years still contain enough viable nephrons to be made available for transplantation, and whether single or dual transplantation should be used. Allocating kidneys from older donors to a single or dual transplant on the basis of this scoring system allowed achieving a graft survival similar to that of single transplants from ideal donors and remarkably superior to that of single transplants from older donors not evaluated histologically before implantation. Thus, preimplantation histologic evaluation maximizes the success of ECD transplants and protects recipients from receiving organs at increased risk of premature failure. This may limit the number of patients who eventually must resume dialysis and need second transplants.     

Assessment of factors determining graft size in transplant of cadaver kidneys from child donors

BACKGROUND: Kidneys from child donors are very efficient at adapting to the recipient organism. This research aims to verify the size of kidney grafts from pediatric donors after transplant and to identify factors responsible for the size attained by these kidneys. Moreover, it aims to seek relationships between size and function of the transplanted pediatric kidney. METHODS: Seventy-seven renal transplants performed at least 6 months earlier, with cadaver donor 15 years old or younger, had ultrasound measurements of the graft and renal function assessment. Potential factors for graft volume were analyzed using bivariate analysis, followed by multiple linear regression. RESULTS: After a follow up of 4.2+/-3.3 years posttransplant, the grafts presented the following range of measures: length 10.61+/-1.13 cm, width 4.67+/-0.84 cm, and depth 4.76+/-0.99 cm. Graft volumes were 126.62+/-47.76 cm. Bivariate analysis showed that (1) age of both donor and recipient at transplantation; (2) sex of recipient; (3) occurrence of acute rejection episodes were statistically significant. After multivariate analysis, age and sex of recipients were the only significant factors influencing graft volume; child kidneys reached greater volumes when transplanted into adult and male individuals. Larger volume kidneys presented significantly more proteinuria. No difference was evident with regard to creatinine clearance values or urinary retinol binding protein among kidneys of differing sizes. CONCLUSIONS: The size of the recipient (age and sex) is the main factor responsible for volumes achieved by kidneys from pediatric donors. The volume attained by these kidneys demonstrated no relationship with glomerular or tubular function of the organ.     

Hypothermic pulsatile perfusion and transplantation of pediatric cadaveric kidneys into adults.

Twenty-seven adults received en block or single renal allografts from pediatric donors less than 12 years of age. Hypothermic pulsatile perfusion of these small kidneys presented no technical difficulties. Flow rates ranged between 0.8-1.2 ml/min/gm. Single pediatric kidneys from donors as young as three years were able to produce a creatinine clearance of 50 ml/min in adults by one month posttransplant. No differences in renal function were noted between en bloc or single kidneys. En bloc transplants were associated with an increased incidence of renal arterial thromboses (3/8 cases). Because of this, pediatric cadaver kidneys were transplanted as single units, and an additional advantage was that they could provide donor kidneys for two recipients. In our series, one year pediatric graft survival is less than a comparable group of adult cadaveric kidney recipients.     

低龄心脏停跳供者单个肾脏成人移植11例

目的 总结符合脑死亡诊断标准的低龄患儿心脏停跳后供肾应用于成人移植的处理经验.方法 心跳停止后单个供肾患儿6例,月龄49～106(75.35±22.8)个月,体质量16.6～37.8(23.9±8.4)kg.受者11例,平均年龄(28.2±7.9)岁,体质量(46.9±4.2)kg.单个供肾植入受者右侧髂窝.手术方法同成人尸肾移植.术中开始单/多克隆抗体加甲泼尼龙诱导治疗,术后常规环孢素或他克莫司、霉酚酸酯、泼尼松三联免疫抑制剂治疗.结果 受者肾功能均恢复正常,其中出现移植肾功能延迟恢复3例.术后移植肾增大明显,灌注后和移植后1周移植肾长径分别为(70.6±5.5)和(86.1±6.9)mm(P＜0.001),之后移植肾持续缓慢增大,至术后12个月移植肾长径为(104.5±8.8)mm.平均随访时间(21.8±9.5)个月,1年人/肾存活率均为100%.结论 低龄心跳停止供者单个供肾植入低体重的成人受者,可以成功维持受者正常肾功能,1年人/肾存活率与成人尸肾移植无显著差异.     

Renal transplantation in children.

23 children aged 1--16 years of age have received renal transplantation during the years 1972-1975 at the Downstate Medical Center. Of 9 children transplanted from related donors, I died and 3 lost their kidney-2 were retransplanted; 1 lost the second graft. Of 14 children transplanted from cadaver donors, 2 died, and 3 lost their kidney. 3 were retransplanted; 2 of them lost the second and 1 the third kidney as wll. Hypertension is the most frequent early and late posttransplant complication. 65% of the original 25 patients now have functioning grafts and they are rehabilitated. The success of renal transplantation in children is similar to that in adults.