Renal function and somatic growth in pediatric cadaveric renal transplantation with cyclosporine-prednisone immunosuppression

D. Ellis, E. D. Avner, J. T. Rosenthal, R. J. Taylor, L. W. Young, M. A. Palumbi and T. R. Hakala

The posttransplantation courses of 28 consecutive patients (age range, 0.8 to 16 years) who received cadaveric renal allografts and combined cyclosporine-low-dose prednisone immunosuppression were analyzed. The mean follow-up time was 16.5 months (range, four to 42 months). There was one death and the actuarial one-year graft survival was 59%. At follow-up, the group mean (+/- SD) serum creatinine concentration in 14 patients with functioning grafts was nearly double the expected mean value for normal children of similar age and sex (1.13 +/- 0.38 vs 0.61 +/- 0.07 mg/dL), and the mean +/- SD glomerular filtration rate was 76.5 +/- 20.0 mL/min/1.73 sq m (range, 40 to 115.5 mL/min/1.73 sq m). Although rejection accounted for 11 (79%) of 14 graft losses, failure of immunosuppression could be implicated in only four of these patients. Among eight preadolescent patients with good renal function for one year posttransplantation, somatic growth was poor in four and suboptimal in three patients; catch-up growth occurred in one patient. In such patients, the weight-for-height index increased, reflecting the development of obesity after transplantation. We conclude that cyclosporin-low-dose prednisone offers little or no advantage in terms of cadaveric renal allograft survival or stimulation of somatic growth when compared with conventional therapy.