Renal transplantation in infants and small children

There are still concerns about renal transplantation in small children. The aim of this study was to identify prenatal data, underlying diseases, patient and graft survival, graft function and growth in young renal transplant recipients at our center. A retrospective analysis was performed on 50 kidney transplants performed during the period 1981–2008 in children weighing <13 kg. Their median age at transplantation was 1.4 (range 0.4–3.7) years and the median weight was 9.5 (3.4–12.1) kg. The underlying diseases were congenital in 88% of the patients and acquired in 12%. Ten-year patient survival was 88% (82% before 1998 and 95% since 1998). Ten-year graft survival was 82% (75 and 95%, respectively). Graft function (glomerular filtration rate) deteriorated from a mean of 75–48 ml/min/1.73 m² within 10 years. There was rapid catch-up growth within the first years post-transplant, from a median height of −2.44 standard deviation score (SDS) at transplantation to −0.74 SDS after 3 years. In small children, patient and graft survival were as good as those in older children. Renal function deteriorated during the first years post-transplant but stabilized within a few years. In most children, there was a substantial improvement in growth within the first years after transplantation.