Nineteen years of experience utilizing anti-T-Lymphocyte globulin induction in pediatric kidney transplantation.

BACKGROUND: The optimal immunosuppressive therapy in kidney transplantation remains controversial. Since 1990, we included, in our department, anti-T-Lymphocyte globulin Fresenius® (ATG-F) in a sequential immunosuppressive therapy in pediatric recipients of deceased donor kidneys. We analysed retrospectively the complications and long-term outcomes. MATERIAL/METHODS: Ninety eight kidney transplants were performed in 91 children and adolescents between November 1990 and October 2009, using deceased donor source grafts. In 86.8% of the recipients ATG-F was used as antibody induction and in 12.2% of the recipients no ATG-F induction was used. RESULTS: Overall graft survival rates at 1, 5, 10 and 15 years were 91.8%, 86.1%, 75.9% and 61.9% respectively. In the ATG-F group the graft survival at 1, 5, 10 and 15 years was 93%, 89.1%, 79%, 62.4% and in group without ATG-F it was 83.3%, 66.7%, 55.6% at 1, 5, 10 years respectively (p=0.27). The overall incidence of infection was 1.6/patient in the first year post-transplantation and almost all were of mild or moderate intensity. A papillary thyroid carcinoma was diagnosed in one patient and no lymphoid malignancies were observed during the observational period. All patients were alive at the end of follow-up, except one who died of cardiovascular disease, 7 months after graft loss. CONCLUSIONS: These results indicate that ATG-F induction in pediatric kidney transplantation using deceased donor kidneys is associated with good graft and patient survival rates, and with low levels of complications.

Haemodialysis for children under the age of two years.

Less than 10% of children under 2 years old with end-stage renal failure in Europe and in the United States of America are treated with haemodialysis. For small children, peritoneal dialysis is often the preferred treatment. Haemodialysis is chosen for a very small number of children, and is only used in some selected centres because of its highly complex technique, the difficulties related to vascular access, and the need to have a skilled and experienced nursing and medical team. With the technological development of recent years, the quality of dialysis treatment offered to paediatric patients has improved considerably and haemodialysis is presently considered to be a safe and efficient treatment for acute or chronic paediatric renal impairment. However, because a successful renal transplant continues to be linked to a better quality of life for children with terminal chronic renal impairment, dialysis ought to be regarded as a temporary treatment method, while waiting for a renal transplant.