PEDIATRIC UROLOGY

Kidney transplantation in children: impact of young recipient age on graft survival
Lufft V, Tusch G, Offner G, Brunkhorst R
Abteilung Nephrologie, Zentrum Innere Medizin und Dermatologie, Hannover, Germany
Nephrol Dial Transplant. 2003; 18: 2141-6

• Background: It has been suggested that recipient age may have an effect on renal graft survival due to its potential influence on the competence of the immune system. A comparison of graft survival between children and elderly adults, however, has never been performed.
• Methods: Forty patients £ 18 years old were included in the study group and compared with a control group of patients ³ 65 years using a case-control analysis. Apart from age, matching criteria were the number of HLA mismatches and the date of transplantation.
• Results: The mean age differed by 57 years between study and control group (10 +/- 5 vs 67 +/- 2, P < 0.001). There was no difference in the number of initially non-functioning grafts, sex distribution, immunosuppression, number of HLA mismatches on the HLA-DR, -B and -A locus, cold ischaemia time and the number of patients with panel-reactive antibodies. The only difference was a lower donor age in the study group (17 +/- 14 vs 35 +/- 16, P < 0.001) compared with the control group. During the follow-up of 109 +/- 54 and 79 +/- 49 months, respectively, acute rejections were more frequent in the study group (25 vs 12, P < 0.01). There was no significant difference in graft survival between both groups when death with functioning graft was excluded.
• Conclusions: This study which compares two groups of patients with a mean age difference of 57 years could not demonstrate an effect of young recipient age on graft survival, though the incidence of acute rejections appeared to be significantly higher in the paediatric population. Thus paediatric renal transplanted patients do not seem to have a disadvantage regarding graft survival due to their young recipient age.
  
  
• Editorial Comment
  Renal failure is being seen with increasingly frequency in young children. Most of them stay on dialysis for a relatively short period of time and are treated with renal transplantation as soon as feasible. The technical challenges of transplanting into small recipients are considerable and well recognized. What has not been well assessed is whether immunological differences make rejection more common in pediatric recipients.
  In this study, the results of renal transplantation in 40 pediatric recipients were compared with those seen in a control group of adults > 65 years of age. Interestingly, the children suffered twice as many episodes of acute rejection as the adults, but when death with a functioning graft was excluded from the analysis, graft survival was virtually identical. Hence, even though there may be an increased immunocompetence in children, the rate of survival of renal transplantation is the same as in adults. It remains to be seen whether more aggressive immunosuppression in children would be useful.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA