RENAL-TRANSPLANTATION IN CHILDREN AND ADOLESCENTS - THE 1992 ANNUAL-REPORT OF THE NORTH-AMERICAN PEDIATRIC RENAL-TRANSPLANT COOPERATIVE STUDY

被引：61

作者：

MCENERY, PT ^{[1
]}

ALEXANDER, SR ^{[1
]}

SULLIVAN, K ^{[1
]}

TEJANI, A ^{[1
]}

机构：

[1] SUNY,HLTH SCI CTR BROOKLYN,NAPRTCS,CTR CLIN COORDINATING,BROOKLYN,NY 11203

来源：

PEDIATRIC NEPHROLOGY | 1993年 / 7卷 / 06期

关键词：

RENAL TRANSPLANT; MALIGNANCY; GROWTH; IMMUNOSUPPRESSION; END-STAGE RENAL DISEASE; GRAFT SURVIVAL; PATIENT SURVIVAL;

D O I：

10.1007/BF01213331

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

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.

引用

页码：711 / 720

页数：10

共 11 条

[1]

Alexander S.R., Arbus G.S., Avner E., Baluarte J., Butt K.M.H., Chavers B., Conley S., Feldman H., Fine R., Greifer I., Harmon W.E., McCabe D., McEnery P., Novak J., Salvatierra O., Stablein D., Tejani A., The 1989 report of the North American Pediatric Renal Transplant Cooperative Study, Pediatr Nephrol, 4, pp. 542-553, (1990)

[2]

McEnery P.T., Stablein D.M., Arbus G., Tejani A., Renal transplantation in children: a report of the North American Pediatric Renal Transplant Cooperative Study, N Engl J Med, 326, pp. 1727-1732, (1992)

[3]

Rizzoni G., Ehrich J.H.H., Brunner F.P., Brynger H., Dukes S., Geerling S.W., Fassbinder W., Tufveson G., Selwood N.H., Wing A.J., Combined report on regular dialysis and transplantation of children in Europe, 1988, Nephrol Dial Transplant, 4, pp. 31-40, (1989)

[4]

Najarian J.S., Frey D.J., Matas A.J., Kristen J., Gillingham, So S.S.K., Cook M., Chavers B., Mauer S.M., Nevins T.E., Renal transplantation in infants, Ann Surg, 212, pp. 353-367, (1990)

[5]

Ettenger R.B., Rosenthal J.T., Marik J., Salusky E., Kamil M.H., Malezkadeh, Fine R.N., Successful cadaveric renal transplantation in infants and young children, Transplant Proc, 21, pp. 1707-1708, (1989)

[6]

Briscoe D.M., Kim, Lillehei C., Eraklis A.J., Levey R.H., Harmon W.E., Outcome of renal transplantation in children less than two years of age, Kidney Int, 42, pp. 657-662, (1992)

[7]

Ehrich J.H.H., Rizzoni G., Brunner F.P., Fassbinder W., Geerling S.W., Mallick N.P., Raine A.E.G., Selwood H., Tufveson G., Renal replacement therapy for end-stage renal failure before 2 years of age, Nephrol Dial Transplant, 7, pp. 1171-1177, (1992)

[8]

Harmon W.E., Alexander S.R., Tejani A., Stablein D., The effect of donor age on graft survival in pediatric cadaver renal transplant recipients — a report of the North American Pediatric Renal Transplant Cooperative Study, Transplantation, 54, pp. 232-237, (1992)

[9]

Arbus G.S., Pediatric patients in 1989. Canadian Organ Replacement Register, 1989 Annual Report, pp. 71-100, (1991)

[10]

Harmon W.E., Stablein D., Alexander S.R., Tejani A., Graft thrombosis in pediatric renal transplant recipients, Transplantation, 51, pp. 406-412, (1991)

← 1 2 →