[Kidney transplantation in pediatric patients: 18-year experience at Hôtel-Dieu de France]. / LA TRANSPLANTATION RÉNALE CHEZ L'ENFANT Dix-huit ans d'expérience à l'Hôtel-Dieu de France.

ABSTRACT

INTRODUCTION: During the period from September 1993 to March 2011, 79 kidney transplants in children and adolescents less than 18 years old were performed in our department; fifty-six in the familial group and 13 in the cadaveric group. We report in this study immunosuppression protocols, medical and surgical complications (including rejection episodes), graft and patient survival. MATERIAL AND METHODS: Immunosuppression protocol has been modified throughout those eighteen years. Induction therapy includes serum anti- lymphocyte + cyclosporine + azathioprine and prednisone. Since 2000, azathioprine was replaced by mycophenolate mofetil and since January 2005 cyclosporine was given as well as tacrolymus according to EBV status. Basiliximab-Simulect® was included in the protocol since 2010. RESULTS: Surgical complications were only two lymphoceles, reversible after surgical drainage in the peritoneum. Medical complications were mainly infections or rejections. Thirty-six episodes of rejection occurred 7 in the commercial group, 16 in the familial group and 13 in the cadaveric group. At the end of the study, 9 patients returned to dialysis, 5 from the cadaveric group, 2 from the familial group and 2 from the commercial group. CONCLUSION: After eighteen years experience in kidney transplant, we believe that kidney transplant remains the optimal treatment for terminal renal failure even for children weighing less than 10 kg. The follow-up of pediatric patients with kidney transplant revealed different positive effects on growth, regular school attendance and psychomotor development. At the end of the study 24 are at school, 12 at universities, 5 are attending specialized schools and 9 are active workers.