Clinical management and outcome of preemptive renal transplantation in children and adolescents

Background. Recently, pediatric renal transplantation without prior maintenance dialysis (preemptive transplantation) has been performed. The details of perioperative management and outcomes of preemptive transplantation in Japanese pediatric recipients are unclear. Methods. Patients who received preemptive renal transplantation at the age of 18 or younger were studied retrospectively. Results. Eight patients with a mean age of 13 received preemptive transplantation from a parental donor. Their mean creatinine clearance was 8.4ml/min per 1.73 m2 at the time of transplantation. Two patients required treatment for hyperkalemia before transplant. Initial immunosuppressive therapy was the conventional protocol in one recipient, cyclosporine in three, and tacrolimus in four. Three recipients developed clinical acute rejection between 6 days and 1 month posttransplant and were treated with high-dose methylprednisolone and deoxyspergualin. Noncompliance with immunosuppressive drug therapy was identified in one recipient and suspected in another. The follow-up period was between 6 months and 25 years after preemptive transplantation. All recipients were alive with functioning grafts at the last follow-up. The primary reason for selecting preemptive transplantation was the parent's desire to avoid dialysis. Conclusion. Preemptive transplantation was safe and successful. Preemptive transplantation should be performed before dialysis is indicated to avoid hyperkalemia at the time of the operation. Patients who receive preemptive renal transplantation should be followed closely for noncompliance with immunosuppressive drug therapy.