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Fig. 13B.1. (A) Patient survival for recipients on sequential (n CsA) vs. immunsuppression. Number of patients at risk is indicated in parentheses. (B) Graft survival recipients on sequential vs. on CsA immunosuppression. Number of patients at risk is indicated in parentheses. Reprinted with permission from Almond PS, Matas AJ, Gillingham K et al. Transplantation 1992; 53:46-51. © 1992 Williams & Wilkins.

Table 13B.4. Serum creatinine (mg%) with sequential immunosuppression, living donor vs. cadaver

Follow-up Living donor

Cadaver

P value

1 week 1 month

1 year

2 years

3 years

4 years

5 years

6 years

0.6 ± 0.6 (n=57) 0.6 ± 0.5 (n=79) 0.6 ± 0.5 (n=64) 1.2 ± 1.1 (n=49) 1.1 ± 0.7 (n=34)

1.2 ± 0.7 (n=34) 1.1 ± 0.5 (n=29) 1.1 ± 0.5 (n=20) 1.1 ± 0.6 (n=13) 1.0 ± 0.4 (n=8)

Reprinted with permission from Almond PS, Matas AJ, Gillingham K et al. Transplantation 1992; 53:46-51. © 1992 Williams & Wilkins.

Renal allograft function for CsA recipients is shown in Table 13B.4.6 For the first posttransplant year, serum creatinine is significantly lower in LD (vs. cadaver) recipients and in primary (vs. retransplant) recipients. Overall, there is no significant difference in serum creatinine levels in CsA (vs. non-CsA) recipients suggesting no long-term affect of CsA-nephrotoxicity on graft function.

The impact of dialysis and transplantation on growth and development is a major focus. Growth data are reported as z scores which are defined as the patients measurement (i.e., height, weight, or head circumference) minus the 50th percentile for age and sex, divided by the standard deviation (for that measurement) for age and sex. NAPRATCS data show potential recipients are 2.2 standard deviations (SD) below the mean for height.7 Two factors that impact on posttransplant growth are initial height deficit and recipient age.8 Children < 1 year at transplant and those with the lowest z score are the only children that demonstrate catch up growth (i.e., growth > 1 SD). Children older than 6 years show neither accelerated growth nor an adolescent growth spurt. Head circumference is a direct reflection of brain growth. Infants on dialysis have decreased head circumference and cognitive deficits. A successful transplant significantly improves head circumference and decreases developmental delay.

Acknowledgment

Special thanks to Dr. Oscar Salvatierra for reviewing and editing this chapter.

References

1. United States Renal Data System, USRDS 1998 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Disease, 1998.

2. Matas AJ, Najarian JS. Kidney Transplantation. In: Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, ed. Pediatric Surgery. 5th ed. Mosby-Year Book Inc., 1998; 563-580.

3. Warady B, Watkins S. Current advances in the therapy of chronic renal failure and end stage renal disease. Seminars in Nephrology 1998;18:341-354.

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