Abstract 1992

From 1987 through January 1998, the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) has enrolled 6038 transplants performed in 5516 children. Since the initiation of NAPRTCS several changes in the practice patterns for cadaver donor (CD) transplantation have been observed. There has been a steady decline in the use of young donors for CD transplantation from 37% in 1987 to 13% in 1996. In addition there has been a marked reduction in the number of random transfusions received prior to transplantation (from 54% to 37% receiving >5 transfusions), higher doses of maintenance cyclosporine being used (from 6.5 to 7.5 mg/kg), and a decrease in the use of azathioprine (from 84% in 1987 to 35% in 1997). These changes in practice patterns have improved one-year graft survival of CD transplants each year so that the most recent data show CD graft survival to be as good as the LD graft survival seen in 1987: (Table)

Table 1 One-Year Graft Survival (%)
Full size table

Relative risk (RR) factors for CD graft survival are recipient age <2 yrs. (RR=1.95), donor age < 6 yrs. (RR=1.26), absence of T-cell antibody prophylaxis (RR=1.6), >5 prior transfusions (RR=1.31), and Black race (RR=1.34). Using a linear term for year of transplant there is a decrease in the RR (RR=0.92 per year, p<0.001). With improved graft survival there is also a decrease in graft loss due to acute rejections; most graft failures now reported in children transplanted 3 years ago are due to chronic rejection.

Conclusion: With improved graft survival among CD recipients attention needs now to be focused on preventing chronic rejection.