Complications by age in primary pediatric renal transplant recipients

  We asked whether pediatric renal transplant recipients, subgrouped by age, differed in the percentage and number of hospital readmissions and in the incidence of infectious complications post transplant. Between 1 August 1985 and 31 October 1993, a total of 164 patients <18 years of age underwent primary transplants, with cyclosporine-based immunosuppression, at the University of Minnesota. The percentage of readmissions (P = NS), the mean number of readmissions (P = NS), and the length of hospital stay during readmission (P = NS) did not differ significantly among age groups. The overall incidence of acute rejection was greater in those ≥2 years than those <2 years (P = 0.002), and in living donor recipients ≥2 years versus those <2 years (P = 0.02). The incidence of bacterial infection (<2 years, 87%; 2 – 5 years, 72%; 6 – 12 years, 51%; 13 – 17 years, 40%) was greater in younger recipients (P = 0.0001). The most common bacterial infection in recipients ≤5 years was Clostridium difficile-associated diarrhea; in those >5 years, urinary tract infection. The overall incidence of viral infection did not differ among groups (P = NS). The most common viral infection in recipients ≤5 years was varicella and those >5 years, cytomegalovirus infection. Risk factors for infection in the first 6 months post transplant included age <2 years and Solu-Medrol treatment for acute rejection. In conclusion, young recipients <2 years of age at the time of transplant are at a higher risk for bacterial infection post transplant.