Graft survival and complications of living donor pediatric renal transplant: A tertiary center experience

Introduction: Transplantation is the preferred method of treatment for end-stage renal disease in children. Besides providing superior quality of life, it is economical in the long term compared to the continuous ambulatory peritoneal dialysis (CAPD) and maintenance hemodialysis (HD), which is difficult in children. We share our experience in renal transplantation in children. This retrospective study is an attempt to analyze the results and complications of pediatric renal transplantation at our center. Materials and Methods: Patients below the age of 18 years who underwent renal transplantation between 2003 and 2014 were reviewed retrospectively. Variables analyzed were etiology of ESRD, pre-transplant renal replacement modality, donor relationship, surgical complications, rejection episodes, immunosuppression regimens, graft survival and overall survival. Results: 36 patients underwent live related renal transplant between 2003 and 2014. The mean age was 15 years (range 10-18 years). The cohort consisted of 20 (55%) females and 16 male (45%) recipients. The etiology of ESRD was chronic glomerulonephritis (n = 20), chronic interstitial nephritis (n = 12) and unknown in 4 patients. 34 patients were on maintenance hemodialysis, 1 on peritoneal dialysis and 1 had pre-emptive transplant. All patients received grafts from their first-degree relatives. Parents were the donors for 35 patients, with mothers and fathers being the donor in 29 and 6 cases respectively. Grandmother was the donor for 1 patient. We had 4 cases with acute rejection that were managed as per protocol. There was one case of renal vein thrombosis for which graft nephrectomy had to be done. Overall we had 4 graft loss with graft nephrectomy being done for 2 of these patients. Graft survival at the end of 1 year, 3 year and 5 year graft survival was 90.9% and 86.2% and 78% respectively. Conclusion: Chronic glomerulonephritis was the most common etiology of renal failure in our study. The graft survival rates are comparable to those from other centers in India, however, 5-year graft survival is inferior to that of developed countries.