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End‐stage renal failure in children: 16 years' experience at one Australian centre
Author(s) -
Hodson Elisabeth M.,
Knight John F.,
Roy L. Paul,
Shiel A.C. Ross,
Harris John P.,
Rogers John R.,
Stephen Michael S.,
Boulas John,
Thompson John F.,
May James
Publication year - 1990
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1990.tb120918.x
Subject(s) - medicine , dialysis , transplantation , prednisone , surgery , stage (stratigraphy) , end stage renal disease , pediatrics , hemodialysis , paleontology , biology
Sixty‐five children over one year and under 15 years of age began treatment for end‐stage renal failure between 1973 and 1988. Sixty‐one renal transplants were performed in 53 children, 39 of these were from living donors (38 were first‐degree relatives and one was an emotionally related volunteer). Thirteen children, of whom seven had received transplants and six had not, died, including three children with functioning transplants; nine deaths occurred in the first eight years of the programme. Cumulative five‐year and 10‐year patient survival rates were 78% and 75%, respectively. Eighteen transplants failed, 12 as a result of rejection, five as a result of disease recurrence and one due to primary non‐function. Cumulative five‐year and 10‐year transplant survival rates for first grafts were 66% and 53%, respectively. For living donor transplants these rates were 85% and 68%, respectively. Growth rates fell by 0.4 ± 0.05 standard deviation score (SDS) per year in children undergoing dialysis, were normal in children with renal transplants receiving prednisone (change in SDS per year, ‐0.02 ± 0.08) and increased by 0.36 ± 0.07 SDS per year in children with transplants receiving cyclosporin A alone. Currently, 32 (82%) of 39 transplant recipients and 7 (58%) of 12 patients undergoing dialysis attend school or work full time. Although both dialysis and transplantation are acceptable therapies for children with end‐stage renal failure, successful transplantation provides the best opportunity for satisfactory growth and development.