Pediatric Renal Transplantation in Syria: A Single Center Experience

Renal transplantation (RTx) is widely accepted as the preferred method of treatment for children with end-stage renal disease (ESRD). This is a retrospective analysis of the results of RTx in children performed at the Surgical Kidney Hospital, Damascus, Syria. Between November 2002 and November 2004, a total of 176 RTx procedures have been performed in our center. Of them, 11 recipients (6%) were younger than 14 years of age. The mean age was 11 years with range of 5 to 14 years. There were six males (55%) and five females (45%). All patients received kidneys from living donors. Seven donors were related (64 %) while four (36%) were unrelated. The cause of ESRD in these patients were reflux nephropathy in three, nephronophthisis and hypoplastic kidneys in two cases each and polycystic kidney disease, rapidly progressive crescentic glomerulonephritis, Alport's syndrome and chronic pyelonephritis in one patient each. All grafts were placed extra-peritoneally. Immunosuppression was based on triple therapy with cyclosporine (CsA) mycophenolate mofetil (MMF), and prednisolone. Tacrolimus (TAC), MMF, and prednisolone, and sirolimus (SRL), MMF, and prednisolone were used in one patient each. Induction immunosuppression in immunologically high-risk patients was, with anti-thymocyte globulin (ATG) in one patient and basiliximab in two patients. The mean duration of follow-up was 12 months {3 to 24 months}. All 11 (100 %) patients were alive at last follow-up with functioning graft. Ten patients (88%) had normal graft function and one (12%) had mild graft dysfunction. Complications encountered were infections in four patients, early steroid-responsive acute rejection in one patient, and mild biopsy-proven chronic rejection in another patient; the latter probably due to poor compliance. No urological complications were encountered. Our study, despite involving a small number of patients with a relatively short duration of follow-up, suggests that the results of pediatric renal transplant at our center are encouraging.