Renal transplantation in children and adolescents: the 1992 Annual Report of the North American Pediatric Renal Transplant Cooperative Study

From January 1987 to January 1992 the North American pediatric Renal Transplant Cooperative Study registered and followed 2,037 children and adolescents 17 years of age or less who received 2, 197 renal transplants at 75 participating centers in the United States and Canada. The cumulative experience over 5 years of data collection demonstrated trends in renal transplantation practice for pediatric patients. The percentage of live donor organ recipients receiving donor-specific blood transfusions decreased from 40% in 1987 to less than 12% in 1991; random blood transfusions also were used less frequently during the most recent 2 years of the study. Immunosuppressive therapy on posttransplant day 0 or 1 with polyclonal and monoclonal antilymphocyte agents was used in over 40% of transplants. There was also a notable preference for the combined use of prednisone, azathioprine and cyclosporine as maintenance immunosuppression. The percentage of live donor source graft recipients receiving cyclosporine increased from 78% in 1987 to 90% in the most recent year, and considered together, nearly 90% of live donor and cadaver organ recipients received cyclosporine. The observed graft survival probabilities for live donor grafts were 88%, 83%, 81% and 76% at years 1–4 post transplantation, respectively. The 1st through 4th year graft survival probabilities for cadaver grafts were 74%, 68%, 63% and 58%, respectively. The five most common causes of pediatric end-stage renal disease have remained as: hypoplastic-dysplastic kidney, obstructive uropathy, focal segmental glomerulosclerosis, reflux nephropathy and systemic immunological diseases throughout the 5 years of this study. There has been a decrease in children 2 years of age or less undergoing transplant surgery. On average, 50% of graft failures were due to the various forms of rejection. Vascular thrombosis (14%) and recurrence of primary renal disease (7%) were the next most frequently encountered causes of graft failure. Poor linear growth was identified as a problem affecting the majority of children both before and after transplantation. Post transplant linear growth was best among recipients less than 6 years of age at transplantation and recipients of all ages who received alternate-day prednisone. A total of 16 malignancies were reported during the 5 years of study. A total of 105 deaths were reported, with infection (41%) the most common primary cause of death. The 2-year patient survival probabilities were 95.5% and 93% for recipients of live donor and cadaver grafts, respectively.Center City InvestigatorAkron Children's Hospital Akron Ian Dresner, M. D.All Children's Hospital St. Petersburg James Prebis, M. D.Arkansas Children's Hospital Little Rock Eileen Ellis, M. D.BC Children's Hospital Vancouver David S. Lirenman, M. D.Bowman Gray School of Medicine Winston-Salem William B. Lorentz, M. D.Cardinal Glennon Hospital St. Louis Ellen Wood, M. D.Children's Hospital Medical Center Cincinnati Paul T. McEnery, M. D.Children's Hospital National Medical Center Washington Edward J. Ruley, M. D.Children's Hospital of LA Los Angeles Paul S. Kurtin, M. D.Children's Hospital of Michigan Detroit Alan B. Gruskin, M. D.Children's Hospital of Pittsburgh Pittsburgh Demetrius Ellis, M. D.Children's Hospital of Wisconsin Milwaukee Heinz E. Leichter, M. D.Children's Hospital Boston William E. Harmon, M. D.Children's Hospital Columbus Mark I. Menster, M. D.Children's Hospital Denver Gary M. Lum, M. D.Children's Kidney Center Buffalo Leonard Feld, M. D.Children's Medical Center Dallas Steven R. Alexander, M. D.Children's Memorial Hospital Chicago Richard Cohn, M. D.Children's Renal Center Galveston Luther B. Travis, M. D.Cleveland Clinic Foundation Cleveland Ben Brouhard, M. D.Columbia Presbyterian Medical Center New York Martin A. Nash, M. D.Duke University Medical Center Durham Delbert R. Wigfall, M. D.ECU School of Medicine Greenville Roberta Gary, M. D.Eastern Virginia School of Medicine Norfolk Michael J. Solhaug, M. D.Egleston Hospital for Children Atlanta Barry Warshaw, M. D.Greisinger Medical Center Danville Oscar Oberkircher, M. D.Hospital St. Justine Montreal Marie Jose Clermont, M. D.Hospital for Sick Children Toronto Diane Hebert, M. D.Johns Hopkins Univ School of Medicine Baltimore Barbara Fivush, M. D.J. W. Riley Hospital for Children Indianapolis Sharon Andreoli, M. D.Kosair Children's Hospital Louisville Harold Harrison, M. D.Loma Linda University Medical Center Loma Linda Shobha Sahney, M. D.Massachusetts General Hospital Boston John T. Herrin, M. D.Mayo Clinic Rochester Dawn S. Milliner, M. D.Medical College Hospital at Toledo Toledo Martin M. DeBeukelaer, M. D.Medical College of Virginia Richmond John Foreman, M. D.Medical University of South Carolina Charleston Coral D. Hanevold, M. D.Milton S. Hershey Medical Center Hershey Steven J. Wassner, M. D.Mount Sinai Medical Center New York Kenneth Lieberman, M. D.New York Hospital New York Valerie Johnson, M. D., Ph. D.New York Medical College/Westchester Valhalla Robert A. Weiss, M. D.Oklahoma Children's Memorial Hospital Oklahoma City James Wenzl, M. D.Oregon Health Sciences University Portland Cindy Blifeld, M. D.Phoenix Children's Hospital Phoenix Mel Cohen, M. D.Rainbow Babies and Children's Hospital Cleveland Ika D. Davis, M. D.SUNY Health Science Center at Brooklyn Brooklyn Amir Tejani, M. D.SUNY Health Science Center/Syracuse Syracuse Frank S. Szmalc, M. D.Seattle Children's Medical Center Seattle Sandra Watkins, M. D.St. Christopher's Hospital for Children Philadelphia H. Jorge Baluarte, M. D.St. Francis Renal Institute Honolulu James E. Musgrave, M. D.St. Louis Children's Hospital St. Louis Barbara R. Cole, M. D.Texas Children's Hospital Houston Eileen Brewer, M. D.The Children's Mercy Hospital Kansas City Bradley A. Warady, M. D.Tulane Medical Center New Orleans Frank G. Boineau, M. D.University of Missouri Columbia School of Medicine Columbia Ted D. Groshong, M. D.University of Nebraska/Bishop Clarkson Hospital Omaha Mark T. Houser, M. D.University of Tennesse/Le Bonheur Children's Memphis Shane Roy, M. D.University of Miami/Children's Hospital Center Miami Jose Strauss, M. D.University of Texas HSC at Houston Houston Ronald Portman, M. D.University of Texas HSC at San Antonio San Antonio Ihsan Elshihabi, M. D.University of Alberta Alberta Francis Harley, M. D.University of California at Los Angeles Los Angeles Robert Ettinger, M. D.University of California at San Diego San Diego Stanley A. Mendoza, M. D.University of California at San Francisco San Francisco Donald E. Potter, M. D.University Hospital London David J. Hollomby, M. D.University of Alabama Medical Center Birmingham Edward Kohaut, M. D.University of Illinois Chicago Eunice John, M. D.University of Iowa Hospitals Iowa City Jean Robillard, M. D.University of Kentucky Lexington Elizabeth Jackson, M. D.University of Michigan Ann Arbor Aileen Sedman, M. D.University of Minnesota Hospital Minneapolis Thomas E. Nevins, M. D.University of Utah Salt Lake City Miriam Turner, M. D.University of Vermont Burlington Ann P. Guillot, M. D.University of Virginia Charlottesville Robert L. Chevalier, M. D.University of Wisconsin Hospital Madison Aaron Friedman, M. D.Weiler/Einstein Hospital Bronx Ira Greifer, M. D.Wyler Children's Hospital Chicago Andrew Aronson, M. D.Yale University New Haven Karen Gaudio, M. D.