Laboratory Investigation

Kidney International (1980) 18, 103–109; doi:10.1038/ki.1980.115

Treatment of end-stage renal disease in children: A 15-year experience

Donald E Potter1, Malcolm A Holliday1, Carolyn F Piel1, Nicholas J Feduska1, Folkert O Belzer1 and Oscar Salvatierra Jr1

1Departments of Pediatrics and Surgery, University of California, San Francisco, California

Correspondence: Dr D E Potter, Children's Renal Center, Room A276, University of California Medical Center, San Francisco, California 94143, USA

Received 31 August 1979; Revised 17 December 1979.

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Abstract

Treatment of end-stage renal disease in children: A 15-year experience. From 1964 to 1979, 154 children 1 to 16 years of age with end-stage renal disease (ESRD) were treated in a regional pediatric dialysis and transplant program. The incidence of ESRD was 1.6 per million total population per year. The survival rate of children undergoing dialysis for an average of 10 months was 93%. After living donor kidney transplantation (LD), patient survival rates in 60 children were 89% at 5 years, 83% at 10 years, and 74% at 15 years. After cadaver donor kidney transplantation (CD), patient survival rates in 85 children were 70% at 5 and 10 years. LD kidney survival was 71% at 5 years, 55% at 10 years, and 40% at 15 years, whereas CD kidney survival was 43% at 5 years and 31% at 10 years. The survival of first and second transplants was similar. Patient and kidney survival have improved since 1972. The survival rate of 26 children 1 to 5 years of age was 46%, but patients with Wilms' tumor accounted for most of the deaths. We attribute these favorable long-term results in children to an integrated program of dialysis and transplantation with special pediatric facilities.

Traitement de l'insuffisance rénale terminale chez l'enfant: 15 Ans d'expérience. De 1964 à 1979, 154 enfants de 1 à 16 ans atteints d'insuffisance rénale terminale (ESRD) ont été traités dans le cadre d'un programme pédiatrique régional de dialyse et transplantation. L'incidence de l'ESRD a été de 1,6 par million de population totale et par an. Le taux de survie d'enfants en dialyse pendant une durée moyenne de 10 mois était de 93%. Après transplantations avec des reins de donneurs vivants (LD), le taux de survie chez 60 enfants était de 89% à 5 ans, 83% à 10 ans, et 74% à 15 ans. Après transplantations de reins de cadavres (CD), le taux de survie chez 85 enfants était de 70% à 5 et à 10 ans. La survie des reins de donneurs vivants était de 71% à 5 ans, 55% à 10 ans, et 40% à 15 ans, alors que la survie des reins de cadavres était de 43% à 5 ans et 31% à 10 ans. La survie des premiers et deuxièmes transplants a été semblable. La survie des malades et des reins a été améliorée depuis 1972. Le taux de survie de 26 enfants âgés de 1 à 5 ans a été de 46% et la plupart: des décès sont ceux des malades atteints de tumeur de Wilm. Nous attribuons ces résultats à long terme favorables chez des enfants à un programme de dialyse et de transplantation intégré assorti de modalités pédiatriques particulières.

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References

  1. De Shazo CV, Simmons RL, Bernstein DM, Deshazo MM, Wilmert J, Kjellstrand CM, Najarian JS: Results of renal transplantation in 100 children. Surgery 76:461–468, 1974
  2. Weil R, Putnam CW, Porter KA, Starzl RE: Transplantation in Children. Surg Clin North Am 56:467–476, 1976
  3. Fine RN, Edelbroch HH, Riddell H, Malekzadeh MH, Pennisi AJ, Ettinger RB, Uittenbogaart CH, Korsch BM: Renal transplantation in children. Urology 9(Suppl. 6):61–71, 1977
  4. Martin LW, McEnery PT, Rosenkrantz JG, Cox JA, West CD, Lecoultre C: Renal homotransplantation in children. J Pediatr Surg 14:571–576, 1979
  5. Donckerwolcke RA, Chantler C, Brunner FP, Brynger HAO, Gurland HJ, Hathway RA, Jacobs C, Selwood NH, Wing AJ: Combined report on regular dialysis and transplantation of children in Europe, 1977. Proc EDTA 15:79–112, 1978
  6. Potter D, Belzer FO, Rames L, Holliday MA, Kountz SL, Najarian JS: The treatment of chronic uremia in childhood: I. Transplantation. Pediatrics 45:432–443, 1970
  7. Potter D, Larsen D, Leumann E, Perin D, Simmons J, Piel CF, Holliday MA: Treatment of chronic uremia in childhood: II. Hemodialysis. Pediatrics 46:678–689, 1970
  8. WJ Dixon (ed): Biomedical Computer Programs. Berkeley, California, University of California Press, 1974
  9. Breslow N: A generalized Kruskal-Wallis test for comparing K samples subject to unequal patterns of censorship. Biometrika 57:579–594, 1970 | Article | ISI |
  10. Salvatierra O, Potter D, Cochrum KC, Amend WJC, Duca R, Sachs BL, Johnson RWJ, Belzer FO: Improved patient survival in renal transplantation. Surgery 79:166–171, 1976 | PubMed | ISI |
  11. Potter D, Holliday MA, Wilson CJ, Salvatierra O, Belzer FO: Alternate-day steroids in children after renal transplantation. Transplant Proc 7:79–82, 1975 | PubMed | ChemPort |
  12. Cochrum KC, Salvatierra O, Belzer FO: The correlation between MCL stimulation and graft survival in living related cadaver kidney transplants. Ann Surg 180:617–621, 1974
  13. Meadow R, Cameron JS, Ogg C: Regional service for acute and chronic dialysis of children. Lancet 2:707–709, 1970
  14. Pendreigh DM, Heasman MA, Howitt LF, Kennedy AC, MacDougall AI, MacLeod M, Robson JS, Stewart WK: Survey of chronic renal failure in Scotland. Lancet 1:304–307, 1972 | PubMed |
  15. Scharer K: Incidence and causes of chronic renal failure in childhood. Proc EDTA 8:211–214, 1971
  16. Leumann EP: Die chronische niereninsuffizienz im kind-esalter: Ergebnisse einer Schweizerischen rundfrage. Schweiz Med Wochenschr 106:244–250, 1976
  17. Dockerwolcke RA, Chantler C, Brunner FP, Brynger H, Hathway RA, Jacobs C, Selwood NH, Wing AJ: Combined report on regular dialysis and transplantation of children in Europe, 1978. Proc EDTA in press
  18. The ninth report of the Human Renal Transplant Registry. JAMA 220:253–260, 1972
  19. Hodson EM, Najarian JS, Kjellstrand CM, Simmons RL, Mauer SM: Renal transplantation in children ages 1 to 5 years. Pediatrics 61:458–464, 1978
  20. Murray JE, Tilney NL, Wilson RE: Renal transplantation: A twenty-five year experience. Ann Surg 184:565–673, 1976 | PubMed | ISI | ChemPort |
  21. Starzl TE, Weil R, Putnam CW: Modern trends in kidney transplantation. Transplant Proc 9:1–8, 1977
  22. The 13th report of the human renal transplant registry. Transplant Proc 9:9–26, 1977
  23. Opelz G, Mickey MR, Terasaki PI: Calculations on long-term graft and patient survival in human kidney transplantation. Transplant Proc 9:27–30, 1977

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