Transplantation von spendernieren erwachsener auf kinder

Materials and Methods: We transplanted thirty adult kidneys into children who weighed less than 20 kg between January 1 1983 and June 1, 1996. Twenty-six of the kidneys were from relatives and four were from cadaver donors. Immunosuppresion protocls were based on donor-specific transfusions in seven, cyclosporine induction in elven, and antilymphocyte antibody induction in twelve. Results: The one- and five-year kidney graft survival rates were 100% and 50%. The one- and five-year patient survival rates 100% and 94%. Chronic rejection was responsible for seven of the eleven kidney graft losses and four were due to recurrent primary renal disease. The one death was due to bronchopulmonary dysplasia. Hypertension, small stature, and obsity were common srquelae. Conclusions: Adult kidneys can be safely transplanted into small children. The special problems are determining the best fit of kidney graft, removing potassium from the preservation solution when transplanting into children who weigh < 10 kg, treating abdominal catheters as skin during operative site preoperation, dealing with urinary tract abnormalities, making certain that the vascular compartment is full prior to revascularizing the kidney, accepting short stature and obesity after transplantation, and recurrence of focal segmental glomerulosclerosis and hemolytic uremic syndrome in the kidney graft. There may be a role living donor-specific transfusion protocols to reduce the cost of immunosuppression and drug montoring.