Kidney graft loss in children: implications for program development

Background: Graft survival in children who undergo kidney transplantation is lower than that in adults. The objective of the study was to review the experi-ence of the first 22 years of operation of the regional pediatric kidney transplan-tation unit for Atlantic Canada, based at the IWK–Grace Health Centre, Halifax, and to use the results to improve graft survival. Methods: All cases of kidney transplantation performed at the centre from 1971 to 1992 were reviewed and the data compiled with the use of a predetermined database outline. Data for first transplants were analysed and compared with those in North American databases. Of the 40 graft failures, 19 (48%) occurred within the first 3 months after transplantation, a rate similar to that at other cen-tres. The overall survival rates tended to be slightly lower than those of interna-tional databases. The introduction of cyclosporine A as an immunosuppressant, in 1985, did not provide the expected marked improvement in survival. Infec-tion frequently accompanied acute rejection, and there was a delay in treatmen