Pediatric Kidney Transplantation • Siriraj Hospital Experience

ACHRA SUMBOONNANONDA, M.D.*, JARIYA LERTAKYAMANEE, M.D.**, ARUN VONGJIRAD, M.D.*, VIBUL SUNTORNPOCH, M.D.*, PAIBOL JITPRAPHAI, M.D.***

Affiliation : * Department of Pediatrics, **Department of Anesthesiology, *** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

AbstractWe reported six children with end stage renal disease (ESRD) who received kidney trans plantation in our unit from 1996 to 2000. They were 5 boys and 1 girl and their mean age was 9.7±2.7 years (range 6.8 to 13.2). Etiologies of ESRD were congenital anomalies (3 patients), chronic glomerulonephritis (2 patients), and rapidly progressive glomerulonephritis ( 1 patient). Prior to the transplantation, chronic peritoneal dialysis was used in 5 patients, including one who had to switch to hemodialysis due to chronic exit site infection and 1 had preemptive kidney trans plantation.
All children received a kidney from living-related donors, 4 from their fathers, 1 from his mother, and 1 from his elder brother. Triple immunosuppressive drug therapy (prednisolone, azathioprine, and cyclosporine A) was initially given to all patients. Serum creatinine returned to normal within the first week in all patients and 4 patients were discharged home by the end of the second week post operation. Immediate complications included severe hypertension (all patients), ureteral leakage (2 patients), neutropenia (3 patients) and nephrotic syndrome (1 patient). Azathio prine was discontinued in 2 patients due to persistent neutropenia. Cyclosporine A was disconti nued in 1 patient due to hepatotoxicity, this patient was maintained on mycophenolate mofetil and prednisolone. Serum creatinine levels at last follow-up (mean 24.3±19.0 months, range 8-55) were normal in 5 patients and slightly increased ( 1.5 mg/dl) in one. Five patients returned to school full time within 1 year after kidney transplantation. Height standard deviation score improved markedly as early as 6 months post transplant. The cost of maintenance of the immunosuppres sive drugs was similar to adults, i.e. 6,859.1±1,151.8 Baht per month at 6 months post kidney transplantation.
We concluded that kidney transplantation can be performed successfully in selected Thai children with very good results and similar cost of treatment as for adults.

Keywords : Pediatric Kidney Transplantation, Renal Replacement Therapy, End Stage Renal Disease

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