SP898PEDIATRIC RENAL TRANSPLANTATION: SIX YEARS EXPERIENCE OF NEPHROLOGY DEPARTMENT IN SAHLOUL HOSPITAL

Abstract

Introduction and Aims: To evaluate the patient characteristics, complications and outcome of renal transplantation in pediatric end stage renal disease (ESRD) in Sahloul Hospital. Methods: Retrospective observational analysis. Subjects: Children with ESRD undergoing renal transplantation in the last 6 years (December 2007 - December 2013) at the Sahloul Hospital in Sousse Tunisia. Demographic data of the transplant recipients and donors, prior dialysis, surgical details of renal transplantation, immunosuppression, medical and surgical complications and post-transplant follow up and outcome were assessed. Results: : Twenty children aged between 7 and 16 years (mean 12.6 years) underwent renal transplantation in last 6 years at our hospital. The mean weight was 30.4 +/-11.61 kg. Primary cause of renal failure was tubulo-interstitial nephritis in 80% of cases and glomerular nephritis in 20%. All were primary transplants, non pre-emptive and living donors. The donors are mothers and fathers in respectively 57 and 31% of cases. The majority of our recipients (75%) had three or more MHC identities with their donors. The removal of the transplant was performed by lumbotomy in 80% of cases and by laparoscopy in 20%. Implantation of the kidney graft extra-peritoneal and intra-peritoneal in 55 and 45 % of cases respectively. The base of induction immunosuppression was Basiliximab in 85% of cases and polyclonal antibodies in 15% of cases. The graft survival rate (GSR) and patient survival rate (PSR) were 86,9 % and 95 % at 4 years. Acute rejection episodes (AREs) occurred in one patient (5%). Postoperative complications were hematoma in 25% of cases, lymphocel in 20% of cases. Urological complications were reflux in 15% of cases, ureteral stenosis in 10% and renal stones in 5% of cases. Eight children develop hypertension (40%), while diabetes had complicated the evolution of only one child (5 %). Infectious complications were dominated by urinary tract infections (45%) followed by viral infection (CMV, EBV, VZV) in 20% of cases. Hematological complications were anemia in 40% of cases with hemolysis in 15% of cases, neutropenia occurred also in 40% of cases. Mean follow- up was 27+/- 18.3 months. Conclusions: In conclusion, peadiatric kidney transplantation is the treatment of choice for patients with ESRD. Infection seemed to be the major concern after this procedure