Transplantation Series† Cadaver Renal Transplantation in Children Incidence, Immunosuppression, Outcome, and Risk Factors

Summary: In North America, about 50 % of all renal transplants done in children are from a living-related donor source — a figure two and a half times greater than the comparative figure for Europe. Graft survival in children is lower for cadaveric donor (CD) than for living-related donor (LRD) kidneys. Four of 10 children with a CD kid-ney lose their graft within four years. Since it is unlikely that the availability of LRD kid-neys will increase, attention must be focused on improving outcome of cadaver renal transplants in children. This review analyzes factors that affect graft outcome. Young re-cipient age, utilization of kidneys from very young donors, and cold ischemia time are detrimental to prolonged graft survival. Additional factors that impact adversely on ca-daver graft survival are a history of previous transplantation, absence of a DR match, and black ethnic origin of the recipient. An understanding of risk factors to graft sur-vival should enable physicians to optimize cadaver renal transplantation in children